Wiki Billing in a multi-specialty group

[Colliemom]

The practice that I work for is joining with many other practices, of different specialties, to form one large practice.

Each specialty will maintain their own office and staff, but they will all be under one tax ID # with one centralized billing office doing all the billing and coding. (with each physician keeping his/her own NPI #)

In the past, "Dr Smith," a PCP, would see a patient, and when necessary refer the patient to our practice, which is gastroenterology. We would see the patient, and bill a new patient visit. Now Dr Smith will be part of our multi-specialty group. So if Dr Smith sees a patient, as a PCP, and refers the patient to one of our gastroenterologists, would we (the gastroenterologists) still be able to bill a new patient visit? We are wondering if having all the doctors under one tax ID #, will mean we (gastroenterologists) are no longer able to bill new patient visits, if the patient is referred within the group.

 

[shellysk8]

CPT/CMS Definition

Hi,

Both CPT and CMS indicate that a New Patient visit can be billed if the patient has not seen a physician of the "same specialty, same Tax ID" within the past 3 years. Since a PCP and gastroenterologist are different specialties, the New Patient visit code could still be billed, even though you would share the same Tax ID. If one GI refers to another GI under the same Tax ID, then that would NOT qualify as a new patient.

Thanks,
Shelly

 

[mfullerton14]

You need to appeal with a copy of each provider taxonomy and specialty information and it should be payable.
There is also some issues with the patient seeing a provider who is not a doctor (CRNP or PA ect.) because these providers do not have a specialty- make sure all of that info is in the appeal.

 

[ljewomack]

In the past I've been able to avoid claim denials by using different group NPIs for each specialty. Now I am being told that all providers from different specialties must be under the same group NPI. Does anyone know how I can avoid denials and not have to appeal every claim with records? thanks