new/established medicare patients in an outpatient surgical facility?

[GIJohn]

I work at a Hospital owned G.I. clinic that also has a endoscopy suite. I’m told this classifies us as an outpatient surgical facility.

As such new Medicare patients that have NOT been seen by our office, but rather seen by anyone in our hospital owned system within the three years now becomes an established patient. This changes a 99204 patient to a 99214 patient (and cuts 1/3 of my RVUs from those pts)

A few years ago, I was told in passing that they do this so they could charge an extra facility fee For procedures. (However it’” hurts my numbers...)
 
Does anyone else have this problem? I’m assuming that many GI offices have similar issues, But I don't see it anywhere online?

[kristin]

Something about this doesn't seem right. If the hospital based providers these patients have seen outside of your providers are of a different specialty, the patients who are new to your docs should be considered new, not established.

[Michele]

I agree with Kristen but I do believe they go by NPI when determining new or established.  If the billing is being done by the same NPI then that is probably why it's happening.  Doesn't seem right, but that may be why.  Have you tried calling on one to see what the explanation is?