Has it ever happened to you that you reported a new patient code and your MAC rejected it, stating that the patient is already established at your practice? You might not know but this problem could have begun when you enrolled your physician in Medicare. Doctors who are assigned to the wrong specialties in Medicare’s systems can create a host of billing problems down the line.
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That’s the word from a June 27 NGS Medicare “Ask the Contractor” teleconference, in which a caller presented the following scenario: Her internal medicine physician saw a new patient and reported a code from the 99201–99205 series. However, the MAC denied the claim saying that it did not meet new patient qualifications since the practice’s cardiologist had seen the patient in the past.
“That should normally be a new patient visit as long as the doctors are of different specialties,” said NGS’s Jim Bavoso during the call. “But what we have come across more often than not is that the specialties of both members of the group are listed as the same, and that would cause this to bump. What we have found is that we have doctors that are cardiologists who may not have changed their specialty in the program.”
Tip: If such an issue ever happens to you, you can change your specialty in your contractor’s system. Contact your local MAC to confirm which specialty codes your physicians enrolled under, and let the payer...
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