I work for a multi specialty hospital owned physician group. I've always followed CPT and CMS guidelines when billing observation services. If the billing provider isn't the admitting provider then the services must be reported using the out-patient codes 99201-99215. I'm now being told by our revenue department that Humana is the only carrier that follows this rule and for all other carriers, all providers should use the observation codes 99217-99220 or 99224-99226. I sent a copy of CMS IOM addressing this to no avail.
I'm also being told that carriers are no longer using individual NPI specialty/taxonomy to classify if a patient is new or established to a provider but are using the group NPI. Example- If an orthopedic surgeon and a psychiatrist, both employed and billed under the same group NPI and same TID, only 1 of the providers could bill a new patient visit and the other provider would have to bill as an established patient.
Has anyone heard this? I know this quarantine has taken its toll but, really???
Thanks!
I'm also being told that carriers are no longer using individual NPI specialty/taxonomy to classify if a patient is new or established to a provider but are using the group NPI. Example- If an orthopedic surgeon and a psychiatrist, both employed and billed under the same group NPI and same TID, only 1 of the providers could bill a new patient visit and the other provider would have to bill as an established patient.
Has anyone heard this? I know this quarantine has taken its toll but, really???
Thanks!