Wiki NP/PA charging new patient visits-Medicare specialty code

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hollomanh

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When an NP or PA is credentialed with Medicare, they are assigned one specialty type, that specific to NP or PA, not one that would correlate with the actual specialty they are working in. We are a multispecialty group. We have NPs and PAs that will see new patients as state guidelines permit and bill the charges out under their own NPI and get reimbursed the lesser rate. We are having more of a problem these days with their new patient E&M being denied based off the patient having seen another NP or PA in our group. They are working under different specialties and their records clearly reflect it (ie: ENT versus Dermatology). However, we cannot get even the second level processor to pass this claim because ultimately the specialty type is the same. So, E&M guidelines about the advanced clinical practitioners should be treated as the same specialty..., this must be a part of the CPT book Medicare doesn't follow.

Has anyone else had this problem? We just took on a whole new group/new specialty to our organization that comes with a whole new group of extenders. I'm just wondering if anyone has seen this and, if so, if we are fighting a losing battle since ultimately it's all in how Medicare will credential an NP or PA.

Thanks.
 
Unfortunately this is something that happens with the mid-level providers in the same group. I have not heard any rumblings that there is a plan to change the way they are credentialed thru Medicare either.

One of the complicating factors when credentialing mid-levels is that they often go back and forth between different specialties based on need. If they were credentialed as both a NP or PA and a specific specialty that would put an end to their flexibility.


This is just another new patient hoop to jump thru. Hopefully you have access to the scheduling/billing for all the specialties and can avoid most of the rejections for this reason.

Good luck,

Laura, CPC, CPMA, CPC-I, CANPC, CEMC
 
We are having the same problem and are doing redetermination sending the state lic. of which show they are cred in different specialies. We are getting paid.
 
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