Wiki New Practice - New Patient denials

[susie59]

Good Afternoon,

We are a new medical practice with a NEW TAX ID and a NEW NPI GROUP NUMBER. Our provider, has had patients coming to see him from his former practice. Since we are a new medical group with no association to the other practice, we were billing these claims out with a new patient CPT code. These claims have now rejected we are being told by Medicare because our provider had seen these patients in the past three years at his former practice.

Are these claims rejecting correctly?

Thank you,

susie

 

[susie59]

I found the answer. The denials were correct.

http://www.retinalphysician.com/issues/2014/jan-feb/coding-q-a


Q10. Doctor A is new to our group. If a former patient sees Doctor A under our group, is this patient new or established? If the former patient has a visit with Doctor B, in our group with the same specialty as Doctor A, is the patient new or established?

A10. If Doctor A sees his/her former patient, the service is an established patient visit. Doctor A's NPI shows the provider has seen the patient within the previous three years. If the patient sees Doctor B under the new group with the same specialty without seeing the Doctor A first under the new group, then the patient is considered a new patient because the Tax ID is different. -

See more at: https://www.supercoder.com/my-ask-an-expert/topic/new-patient-2#sthash.z0L7y7wI.dpuf

 

[CodingKing]

Correct they are always established to the provider (if face to face in last three years). The rest only comes to play if they are new to the provider but not to the practice.