Wiki New or Established Visit - Same Med Group

[dimey]

My question is this......patient seeing Dr. Smith. Patient diagnosed with Diabetes so Dr. Smith wants patient to see Endo Specialist, Dr. Jones, who happens to be in same group practice but patient has never seen Dr. Jones before.

Everything I've read for years is subject to interpretation except when it comes to the Group Tax ID number, which all the docs, in this scenario, fall under.

In your opinion, can Dr. Jones charge Mr. Patient for a New Visit, even though Dr. Jones, Specialist, falls under same Group Tax ID number as Dr. Smith, Internist?

Appreciate whomever would care to chime in.

Thanx, Teri

 

[blonde01]

That's where the taxonomy code comes into play. You may have to contact the insurance companies to find out what needs to be done to correct the way they are being processed.

 

[cheermom68]

new

As long as no one of the same specialty in that practice has seen the patient in the last three years, he can bill a new patient.
LeeAnn

 

[kostecki]

I agree with Lee Ann, if Smith and Jones are physicians of different specialities billing under the same group tax ID number, and as long as the patient hasn't seen another endocrinologist within that group practice within the last 3 years, then you should be able to bill a new pt visit for her visit with Dr Jones.