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Thread: Group or Not?

  1. #1
    Join Date
    Apr 2007
    Albuquerque, NM

    Exclamation Group or Not?

    AAPC: Back to School
    Ok, here's the story...we are a Multi Physician Practice owned by a hospital. We bill under one tax ID, and have been told by our IPA Contracting department that we are "technically" not considered a "GROUP". I know what the definition of a Medical Group is:

    A group medical practice consists of two or more physicians in partnership. Usually, the group shares all responsibilities for patient care.

    Now, are we considered a group? Our physicians are not partners with each other, however, employed.

    My other question is if we are not considered a group, does the guideline for Multispecialty apply, if a patient is seen by a provider, i.e. FP, then seen by our Cardiologist, is the patient new to the Cardiologist or established? According to the 95 & 97 E&M guideline of an established paitent of a "group" the patient would be established. If we are not a "group" the patient would be considered a New Patient?

    Are you now as confused as I am?
    Last edited by penny48; 07-17-2011 at 02:07 PM.

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