New Patient vs Established for PA who changed jobs/specialty

sjsantjer

Networker
Messages
36
Location
Aberdeen, SD
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0
We are a dermatology office our PA saw a patient who was new to our office, we billed Medicare a new patient E&M, Medicare denied the new patient visit stating that the PA saw the patient at her previous employer a family practice clinic. Medicare states that it didn't matter that we are a complete different clinic and specialty with different group NPI and tax id, because she is still a "PA" that is her specialty. Has anyone else had this issue? Should I change to an established patient visit and re-file, or appeal on the grounds that we are a different specialty and office? Thanks
 

foot

New
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4
Location
North Chesterfield, VA
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NP vs EP

In this instance that visit should be filed as an established patient. You can only bill NP if patient has not been seen by any of the providers within 3 years regardless if they came from different office.
 

CodingKing

True Blue
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3,955
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Specialty and subspecialty only come into play if its a different provider under the same TIN. They are established to the individual provider where ever they go and no matter what specialty they practice under if its been 3 years or less.
 
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