Wiki EP & Cardiologists in same ofc

[heatheralayna]

Please help!

I thought I had this all figured out.... obviously not

We have a group of cardiologists and we recently added an EP doctor. They all bill under the same tax ID#.

If our cardiologists refer a patient to the EP doctor, is this considered a new patient? We are having a difference of opinions here.

In the hospital, again, our cardiologist sees the patient, then the EP doctor or vice versa the EP does a procedure so the patient is now in a global period and the cardiologist sees the patient for a different dx.

I am getting denials all over the place. Should I even spend the time to fight them? I was told the EP doctor was credentialed as an EP doctor, but the insurance companies don't seem to be seeing that way. Do I need to help them see the light (haha)

I'm sure this isn't a new issue. I so appreciate any help/guidance!

 

[jleclerc]

Since your cardiologists and EP specialist are all billing under the same tax ID a patient who is referred to the EP specialist by one of your cardiologists is considered an established patient.

 

[tbanks75]

We have a cardiology office also, and our electrophysiologist joined us a couple of years ago. This is the first that I have heard of this - does anyone have a reference that I can go to to the information stating that if a Cardiologist refers to an EP doctor within the practice that the EP doctor can't charge as a new patient visit. Also the tax id number is the same for everyone in our group.

 

[Theresa Yeager]

I bill for a cardiologist and we have multi physician specialities under the same tax ID as long as they are different speciality under same tax ID you can bill as new patient. If you are getting denials from a specific payer I would call and explain these are two different speciality providers.