• Billing services for patient who is new to our practice but not to the physician

    The claims for one of our doctors who has been with our group for over a year keep getting denied when we bill for new patients. The patients were examined at the physician’s previous office, which has no connection to ours. How can we get paid for new patients at our office? We cannot find a modifier. We have denials from Blue Cross, Blue Shield and Medicare.

    All patient claims should be denied if the patients saw the new physician within the past 3 years . Patients are tracked by the physician’s NPI. Not the group. If any patients saw your new doctor anywhere within the last three years, you should be billing as established patients of the practice.