Author Topic: Medicare New patient Qualification not met denial  (Read 1974 times)

Sivakumar

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Medicare New patient Qualification not met denial
« on: October 16, 2013, 04:08:43 AM »
Hi Guys..

We are handling Multi-specialty hospital; all the providers link with Single group tax id. We are often getting a denial from Medicare as “New Patient Qualification not met”. Since the same patient has seen different providers from different specialty. Will it be paid if we do the appeal? Or is there any other way to fix this issue perpetually?

Please advise!!

Thanks!!

RichardP

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Re: Medicare New patient Qualification not met denial
« Reply #1 on: October 16, 2013, 02:08:59 PM »
Others can give a more specific answer, as I don't do hospital billing.  But it seems to me that, if you are billing with "hospital" codes rather than "provider" codes, the insurance carrier sees the patient as specific to a hospital, not specific to a provider.  Therefore, this patient is not a new patient to the hospital each time a new provider sees him.

That logic makes sense to me, but that doesn't mean it is correct.  I am speaking out of ignorance on hospital billing.

Merry

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Re: Medicare New patient Qualification not met denial
« Reply #2 on: October 21, 2013, 02:45:59 PM »
I don't understand what a multi-specialty hospital means. Is this an acute care hospital? Most hospitals handle care for patients with various diagnoses  so I am perplexed but perhaps not understanding correctly. There are special hospitals that treat just joint disease or cancer but they are really unique. If you can give us specifics without giving us PHI that would help us help you. Or are you a hospital based multi-specialty practice?

Merry
« Last Edit: October 30, 2013, 02:37:57 PM by Merry »