Wiki Doctor joining group bringing patients with him

[Jannie53]

I have a question, I have always thought that when an established physician joins a new physician group (changes his TIN) that when he brings his patient's with him, those patients are considered established and not new. I am having a discussion with another coder who believes that the physician can bill his old patients as a new patient visit because he is new to the group. I believe this was addressed and changed in 2007 but I need to confirm what is the proper and compliant way to bill. Appreciate any responses with a resource for reference.

 

[emcee101]

From the WPS (Medicare MAC) website:

Q10. Doctor A is new to our group. If a former patient sees Doctor A under our group, is this patient new or established? If the former patient has a visit with Doctor B, in our group with the same specialty as Doctor A, is the patient new or established?

A10. If Doctor A sees his/her former patient, the service is an established patient visit. Doctor A's NPI shows the provider has seen the patient within the previous three years. If the patient sees Doctor B under the new group with the same specialty without seeing the Doctor A first under the new group, then the patient is considered a new patient because the Tax ID is different.

http://www.wpsmedicare.com/j5macpartb/resources/provider_types/2009_0727_newpatientservices.shtml

 

[teresabug]

correct, the patient is established. although the Provider is in a new "group" his personal NPI stays the same and never changes making all of his patients that "follow" him established.