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Ophthalmology and Optometry Coding Alert

Denial Management:

Avoid Claim Rejections by Checking Practitioner Specialty Code

Published on Wed Jul 11, 2012

Plus: Medicare's one-year payment window causing massive headaches. If you report a new patient code and your MAC rejects it, stating that the patient is already established at your practice, you could be facing a problem that began when you enrolled your physician in Medicare. Doctors who are assigned to the wrong specialties in Medicare's systems can create a host of billing problems down the line. That's the word from a June 27 NGS Medicare "Ask the Contractor" teleconference, in which a caller presented the following scenario: Her internal medicine physician saw a new patient and reported a code from the 99201-99205 series. However, the MAC denied the claim saying that it did not meet new patient qualifications since the practice's cardiologist had seen the patient in the past. "That should normally be a new patient visit as long as the doctors are of different specialties," said NGS's Jim Bavoso [...]
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