Practice Management Alert

Question: If a doctor saw a patient within the last three years but the doctor is now with a different practice or starts his own practice, is it appropriate to bill that patient as a new patient?

Texas Subscriber

 
Answer: The definition of a new patient is one whom the physician, or a physician of the same specialty in a group practice, has not seen within the last three years. It doesnt matter that the physician is now with a different practice.
 
If the physician has treated the patient within three years, the patient is established. Nowhere in CPT does it state that if the physician has seen a patient within three years but has moved to a new location, or started an office with a new tax identification number, that the established patient can be considered new. But, there are physicians who have changed practices and, seeing that the difference in payment between a new patient and an established one at the same level of service is about $100, boost their reimbursement by billing every patient as a new one. Thats fraud, and if you do that on a Medicare claim, you can be fined from $2,000 to $50,000 per line item every time you knowingly bill something incorrectly.

 
You Be the Expert and Reader Questions answered by Jean Acevedo, CPC, LHRM, senior consultant with Acevedo Consulting Inc. in Delray Beach, Fla.; Terry A. Fletcher, BS, CPC, CCS-P, CCS, healthcare coding consultant with McVey Associates in Laguna Niguel, Calif.; and Catherine A. Brink, CMM, CPC, president of Healthcare Resource Management Inc. in Spring Lake, N.J.