Wiki New Patient or Established SAME Group DIff Taxonomy

[jcab2405]

Will Medicare consider a claim as a New Patient when a regular Cardiologist "No Subspecialty" bills, a few years after an electrophysiologist saw the patient?
- We use the same Group NPI
- HRO
- Both Md's are registered correctly in the NPI registry with the proper Taxonomy code as primary.

Thanks

 

[csperoni]

New Patient: An individual who did not receive any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous 3 years.
If the providers are properly credentialed with Medicare under the different specialties, then the cardiologist visit may be billed as a new patient.

 

[jcab2405]

Agreed, which is what I knew - but for some reason Medicare kick the claim under NP qualifications. I will have to review the credentialing which is handled by another department. Thank You

 

[amyjph]

Agree, depends on how they are credentialed. You are correct, according to the provider specialty codes in Ch. 26 Medicare Claims Processing Manual 10.8.2 - Physician Specialty Codes they should be different.