Question observation services

vcar

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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!
 
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Coeur d'Alene, Idaho
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I have not heard of any of what you described above from your revenue department. CMS and CPT are both pretty clear that only the admitting provider can bill for observation services. As to the second issue, all of our carries are still utilizing individual NPI to classify new vs established patients. This allows our specialists in our health system to bill for new patient visits for patients that are referred to them by other practitioners within our group. What is there rationale for determining that only one provider would get the new patient visit and all others are left to bill established? I would challenge the revenue department on this and I would ask to see something in writing from a credible source.
 

vcar

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I've challenged the revenue dept along with supplying carrier documentation and have asked them to provide something in writing from the carrier(s) to back up their statements. Guess I'll just take it up the ladder.

Thanks for the confirmation.
 
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