Wiki billing for new patient visits in a multi-specialty group

[Colliemom]

The practice that I work for is joining with many other practices, of different specialties, to form one large practice.

Each specialty will maintain their own office and staff, but they will all be under one tax ID # with one centralized billing office doing all the billing and coding. (with each physician keeping his/her own NPI #)

In the past, "Dr Smith," a PCP, would see a patient, and when necessary refer the patient to our practice, which is gastroenterology. We would see the patient, and bill a new patient visit. Now Dr Smith will be part of our multi-specialty group. So if Dr Smith sees a patient, as a PCP, and refers the patient to one of our gastroenterologists, would we (the gastroenterologists) still be able to bill a new patient visit? We are wondering if having all the doctors under one tax ID #, will mean we (gastroenterologists) are no longer able to bill new patient visits, if the patient is referred within the group.

 

[swilliams2]

NP

You can still bill new patients as long as your SPECIALTY has not seen the patient within 3 years. The definition is explained in the CPT book just before the E&M section if you need more info.

Thanks,
Stacy

 

[Colliemom]

SWilliams - thank you for responding!

So I know the definition of a new patient is "a patient who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice within the past three years."

But the concern we have is that it also mentions "who belongs to the same group practice," as all the physicians will now be under the same tax ID #, regardless of their specialty. Since the internal medicine physicians will now be linked with the gastroenterologists under the same tax ID, we are concerned that the New patient visits will not be paid. But if the key word is "exact same specialty" then we should be ok.

Do you have experience with billing a multispecialty practice/group? Have you had any issues with getting paid?

 

[swilliams2]

NP

No, I have not done multi-specialty billing -so I am speaking from training, not experience. Maybe someone with exp. will chime in. I was confident in my response because I have heard this question many times in seminars and workshops over the years and the answer has always been the same. The key is the specialty. I think I even saw another post here on the DB abut this. Try searching and see if you can pull it up and see others' response.

Good luck!