REFUND REQUEST

[mruiz12]

I received a refund request from an insurance stating that i should have not billed the first office visit as a new patient visit. We should have billed out for established patient. We have never saw this patient in the office before this first visit. My Dr did see him in the hospital when he was on call. According to this insurance they are stating since the Dr saw him in the hospital then the first visit should have been billed out as an established patient visit. I have never come across this before from any other insurance. Does any one know if they are correct or not?

[kristin]

A new patient is one who has not received any "face to face" services from the provider before(or in the last three years). So yes, the patient was established when they came to the office, because the doctor saw them in the hospital already.

[mruiz12]

@kristin. thank you so much for your reply back. I have never came accross this problem till now.

[kristin]

You are welcome!

Usually, the claim would deny for the new patient code being billed when the patient was already seen, as opposed to what happened to you where they paid it and now want the money back.