Wiki New vs. Established

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tonishea78

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One of the practices I work for have their coding and billing done but a third party company....after reviewing the what has been billed out I have noticed that not one of the NEW patients have been coded as new. The patient H&P's meet all the necessary requirements, and have never been seen by the Dr before. When I inquired about this, their response was that the Dr did not include the phrase "new to my office", so they billed them as established. Am I wrong to think they should have been billed as new??? Do I owe them an apology??:confused::confused::confused:
 
tonishea@gmail.com said:
One of the practices I work for have their coding and billing done but a third party company....after reviewing the what has been billed out I have noticed that not one of the NEW patients have been coded as new. The patient H&P's meet all the necessary requirements, and have never been seen by the Dr before. When I inquired about this, their response was that the Dr did not include the phrase "new to my office", so they billed them as established. Am I wrong to think they should have been billed as new??? Do I owe them an apology??:confused::confused::confused:
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I have never come across any guidance stating that this phrase, or anything like it, must be included in the documentation for a new patient visit. IMO, they are downcoding those visits unnecessarily! Yes, it helps to see something like "patient presents for initial evaluation of...", but even that could just mean a new problem, not a new patient. I do not agree with what they are doing. Can they provide any resources showing this requirement?
 
Dr's wording is everything. Code what you see I suppose = /

Good thing you caught it, that's a nice chunk of change. Ask the physician to add those few key words on the new patients. "Seen for the first time" "New to my practice", etc.

They can't assume everyone is new either, you know?

I don't see in her question where they required him to document that, just a better mutual understanding moving forward.
 
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Thank you both for your input, when I went back through the patient charts and reviewd the office visits, 85% of them documented as "referred to my office" or "referred for evaluation" were coded as established.
 
I would recoup from the billing service! Do they have the authority to change the codes without notice? What the contract state for this situation?
 
Does the billing company contract with your practice specifically say that they are responsible for the coding?

If not, I would hold them (billing company) accountable.

For the accounts you can still submit timely filing corrected claims to, I would do so ASAP.

I have worked over 10 years with 2 different billing companies. Some practices contracted us to do the coding AND billing. Some only the billing.
If there were coding issues the billing company noticed for the practices they only contracted for billing, those issues were sent back to the practice to verify. We NEVER changed the practice coding without written consent from the practice.
 
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