Wiki New Vs Established

[AliMontone]

I just started working for a Hand Surgeon. He was previously employed by an Orthopaedic Group. He is now practicing on his own. I was under the impression that if he had seen a patient at his old practice within the last three years, he must bill as an established patient. The nurse who is doing his billing says no, he has a new "group NPI." His NPI however remains the same and he is seeing patients under this NPI. He is seeing these patients for follow up care of surgery he performed at the old office, as well as new problems. Am I correct in stating that these must be billed as established patients as he has seen them for face to face E/M services within the last three years?

 

[teresabug]

you are correct. Explain to the "nurse" that his group NPI as well as his very own individual NPI is going out on the claim form.

I had the same issue at a previous employer. One of the cardiologists left a major hospital chain and came into private practice with 3 other cardio's. I had many people disagree with me on this until the denials started rolling in.