Wiki Question about billing after urgent care visit

[sghrist]

Our ortho docs see patient's in urgent care and then they will follow up in our office. Billing for urgent care is under a different tax ID than our practice. Would that patient be established or new when they visit our office. I get denied if I bill new but have a physician that feels it should be billed as new. Any help would be appreciated, also if anyone has anywhere to find the documentation of this it would be greatly appreciated.

 

[mitchellde]

once the provider sees the patient in any setting, that makes them an established patient. You can find this in the medicare manual just search under new patient criteria.

 

[CodingKing]

In addition to any setting, under any specialty/practice/TIN even if say provider saw patient in 2 different states. Specialty and practice only come into play when its a different physician.