tci Medicare Compliance & Reimbursement - 2006 Issue 24

BILLING: Same Group, Different Specialty--How To Collect What You Deserve

Stand your ground when your carrier shoots you down on new patient visits.Watch out: It's time to fight for new-patient visits when your patient sees another physician in your group, from a different specialty. The rules: CPT says a new patient hasn't received any services "from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years." The Medicare Claims Processing Manual says physicians "in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the...

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