Jody Mortensen
Networker
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I have 2 questions concerning Medicare guidelines:
1) The definition of a New patient in the Medicare Claims Processing Manual is: "a patient who has not received any professional services from the physician or physician group practice (same physician specialty) within the previous 3 years. We are receiving a deniel from a third-party payor (citing Medicare guidelines) that the claim is denied at the New patient EM level because the patient has been seen at our facility. It was billed as a new patient EM due to seeing a cardiologist whom the patient had not seen prior or any other cardiologist in that specialty. Wouldn't this be considered a New patient? The concern I am hearing from others is that we submit the bill as a group practice so the cardiologists are considered part of the group. I work at a multispecialty facility. Can anyone can help me clear the confusion on this?
2) Medicare patient is seen in clinic by MD for a rash, who then calls in another MD to look at. The MD called in admits the patient to the hospital. My question is: Doesn't Medicare bundle the clinic visit into the admission even though patient was seen by a different MD?
1) The definition of a New patient in the Medicare Claims Processing Manual is: "a patient who has not received any professional services from the physician or physician group practice (same physician specialty) within the previous 3 years. We are receiving a deniel from a third-party payor (citing Medicare guidelines) that the claim is denied at the New patient EM level because the patient has been seen at our facility. It was billed as a new patient EM due to seeing a cardiologist whom the patient had not seen prior or any other cardiologist in that specialty. Wouldn't this be considered a New patient? The concern I am hearing from others is that we submit the bill as a group practice so the cardiologists are considered part of the group. I work at a multispecialty facility. Can anyone can help me clear the confusion on this?
2) Medicare patient is seen in clinic by MD for a rash, who then calls in another MD to look at. The MD called in admits the patient to the hospital. My question is: Doesn't Medicare bundle the clinic visit into the admission even though patient was seen by a different MD?