Wiki Adding new EP Dr

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heatheralayna

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Our practice currently is comprised of 3 cardiologists, we are adding an EP doctor to our group and will be billing with the same tax ID#. I have been told by Noridian Medicare that as long as the doctors have different taxonomy codes (which they do) that we can bill consults for the EP doctor even if they have seen one of our cardiologists in the recent past.

Does anyone have experience/knowledge with this? I am being told by colleagues that insurance companies will only see the tax ID and will deny any/all consults.

Thank you!

Heather
 
All my specialties are under the hospital tax ID as you can imagine there is a lot of them. We also have numerous family practices we have not had any problems. We are in Mississippi I don't know if that would be a factor or not. Good luck.
Colleen CPC :)
 
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Heather,

I work for a 9 physician group w/ 2 EP docs. The only problem that I have encountered is that I can only get the consults paid in appeal. My claims have not paid on the initial bill. Otherwise, this has not been a huge problem. Trailblazers in TX has an explanation on their website about "Consultations paid in the same group". Commercial carriers may have a problem with it. Check the reimbursement policies on each plan to see how they will reimburse you. Hope that helps!
 
Also ...

Make sure you really have a consultation. Is the cardiologist transfering care of the problem to the EP specialist? Or is the cardiologist requesting advice/opinion on management of the problem ... i.e. the EP specialist gives advice to the cardiologist who will actually manage the problem.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
one more thing to consider

The taxonomy code assigned to each individual physician should be on their NPI file; however the taxonomy code does not print on paper claims. It was my understanding that the taxonomy is transmitted electronically. To insure your EP is paid for his/her services they must indicate EP as their specialty with Medicare and all insurance plans. Failure to do this will result in some of the EP services to be denied. Our EP's consultations were denied with Medicare because he was not considered an electrophysiologist with Medicare until he was issued his EP board certification and we indicated his specialty was EP.

I hope this makes sense and has helped you.

Dolores, CPC-CCC
 
Thank you!

Thank you for your help! This makes sense to me. He does have the EP designation, and I know Medicare has his designation correct. Let's just cross our fingers that whomever did that credentialing for him previously did the designation. I know I have called all the big plans and clarified...whew what fun..

Thanks all!
 
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