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Internal Medicine and Specialists in same office

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We received a question from a physician office and there are two different answers we have received internally:

question: we are a practice with PCP's and Specialist. We refer from our pcp's to our specialists. we want to know if we can bill them as new patients.

answer 1: yes, they are new to the specialists bill as a new patient

answer 2: no they are billing under the same TIN therefore the patient is not new to the practice, the patient is established.

-i think the 2nd answer is correct as i am looking for the official answer from medicare that type of scenario is not discussed. where can i find the information that supports answer #2. thx guys!:p
 

btadlock1

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Lubbock, TX
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We received a question from a physician office and there are two different answers we have received internally:

question: we are a practice with PCP's and Specialist. We refer from our pcp's to our specialists. we want to know if we can bill them as new patients.

answer 1: yes, they are new to the specialists bill as a new patient

answer 2: no they are billing under the same TIN therefore the patient is not new to the practice, the patient is established.

-i think the 2nd answer is correct as i am looking for the official answer from medicare that type of scenario is not discussed. where can i find the information that supports answer #2. thx guys!:p
A new patient is one who hasn't received professional services from the same provider, or another provider of the exact same specialty, in the same group practice, anytime in the last 3 years. The specialist's visit considered is 'new'. Hope that helps! ;)
 

btadlock1

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This is a few years old, but...

The info is still relevant: http://www.aafp.org/fpm/2003/0900/p33.html

"In a multispecialty practice, a patient might be considered new even if he or she has received care from several other physicians in the group and a medical record is available. The distinguishing factor here is the specialty designation of the provider. For example, take a patient who has been seen regularly by the pediatrician in your group. The patient is now 18 years old and wants to transfer care to a family physician in the same group. When she sees the family physician, she'll qualify as a new patient because the family physician is in a different specialty than her previous physician. This is the case even though the family physician might be treating her for an existing problem and referring to her established medical record."

You can also find quite a bit of information in the front of your CPT book about it. I believe it's defined in the "Introduction" section, but if it's not there, then it should be in the E/M guidelines. ;)
 
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