New Patient visit

[lmjd]

Our practice shares call with a private practitioner. When seeing his patients we have coded as the guideline states classifying the visit as it would have been by the physician who was not available. In other words, we bill his established patients with those codes. Now there are patient's transferring to our practice from him that I have billed as new patients to our practice. Is this correct? Insurance is denying as new since we have billed in the past as established patients. What do you think? The guideline is not clear on this.
Thanks!

 

[rthames052006]

Our practice shares call with a private practitioner. When seeing his patients we have coded as the guideline states classifying the visit as it would have been by the physician who was not available. In other words, we bill his established patients with those codes. Now there are patient's transferring to our practice from him that I have billed as new patients to our practice. Is this correct? Insurance is denying as new since we have billed in the past as established patients. What do you think? The guideline is not clear on this.
Thanks!

Only if your providers have NEVER seen these pt's in another face to face encounter in the past 3 years, if they have seen them while your physicians were on call for the other doctor, then the answer is no.