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Medicare Compliance & Reimbursement

Denial Management:

Sidestep Billing Headaches By Checking Practitioner Specialty Enrollment

Published on Thu Aug 02, 2012

Dodge the 'no-pay zone' -- inspect your patients' insurance cards. If you MAC rejects a new patient code, you need to verify under which specialty your physician has been enrolled in Medicare. Once a practitioner has been assigned the wrong specialty in Medicare's systems, you are setting yourself up for all kinds of billing challenges and need to set the record straight ASAP. That's the word from a June 27 NGS Medicare "Ask the Contractor" teleconference, in which a caller presented the following scenario: Her internal medicine physician saw a new patient and reported a code from the 99201-99205 series. However, the MAC denied the claim saying that it did not meet new patient qualifications since the practice's cardiologist had seen the patient in the past."That should normally be a new patient visit as long as the doctors are of different specialties," said NGS's Jim Bavoso during the call. "But what [...]
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