ahouse
Guest
I work for a carrier and I'm having a philosophical disagreement with a provider.
They have a large, multispecialty clinic under one TIN. My Carrier (and I think everyone generally agrees) has determined that a 'group practice' is defined by Tax ID.
This practice wants to be able to bill two new patient visits for one patient who has seen two different doctors of the same specialty from two different locations for two different diagnosis codes. To better explain:
01/01/01 99204 171.2 Dr A. is a General Surgeon
01/25/01 99204 682.6 Dr B. is a General Surgeon
Both dates of service are billed as POS 11, both are billed under the same TIN with the same billing address.
The practice wants written proof that these can not both be billed as new patient.
Is the term group practice defined by CMS or the AMA somewhere? Any help you can give would be greatly appreciated!
They have a large, multispecialty clinic under one TIN. My Carrier (and I think everyone generally agrees) has determined that a 'group practice' is defined by Tax ID.
This practice wants to be able to bill two new patient visits for one patient who has seen two different doctors of the same specialty from two different locations for two different diagnosis codes. To better explain:
01/01/01 99204 171.2 Dr A. is a General Surgeon
01/25/01 99204 682.6 Dr B. is a General Surgeon
Both dates of service are billed as POS 11, both are billed under the same TIN with the same billing address.
The practice wants written proof that these can not both be billed as new patient.
Is the term group practice defined by CMS or the AMA somewhere? Any help you can give would be greatly appreciated!