MACT1234
Guest
We are a professional office; billing as a group for our Providers (physicians)
We have a Brand New Patient that has never been to "our" office before...Medicare recently denied the new patient office visit code for frequency of services.
Turns out, our Provider also saw this patient in his private practice within the last three years. Medicare says if the same Physician sees a patient in his private office and then again through our clinic, even though we are billing under a different NPI, we cannot bill it as a new patient, but rather we have to bill it as an established patient.
I re-read the E&M Guidelines, and I still do not see it that way, maybe I am not interpreting it correctly:
"A new patient is one who has not received any professional srvs from the physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the last three years."
Am I CRAZY, or does this guideline refer to physicians within the same group practice only?
We have a Brand New Patient that has never been to "our" office before...Medicare recently denied the new patient office visit code for frequency of services.
Turns out, our Provider also saw this patient in his private practice within the last three years. Medicare says if the same Physician sees a patient in his private office and then again through our clinic, even though we are billing under a different NPI, we cannot bill it as a new patient, but rather we have to bill it as an established patient.
I re-read the E&M Guidelines, and I still do not see it that way, maybe I am not interpreting it correctly:
"A new patient is one who has not received any professional srvs from the physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the last three years."
Am I CRAZY, or does this guideline refer to physicians within the same group practice only?