Wiki Clarification on Patient Status – Provider Transition Between Dermatology Practices

[cphelps@derm-associates.com]

I’m seeking clarification regarding patient billing status in the following scenario:


If a provider transitions from one Dermatology practice to another within the same city and state, will their existing patients be considered new or established at the new practice?


Additional details:

• At the previous practice, claims were billed under the provider’s individual NPI.
• At the new practice, claims will be billed under the group NPI.

Does this change in billing structure impact whether the patients are classified as new or established?


Your guidance on this would be greatly appreciated.


Thank you,

 

[jkyles]

The original doctor's patients are established if they see patients at the new practice within the three year period. The original doctor's patients are also established to all dermatologists at the new practice who are the same specialty and sub-specialty as the original physician.

I think of established patient status as being a highly contagious condition that easily spreads to other providers.

Your MAC likely has a new/established patient decision tree or tool. BCBS Rhode Island has some good examples https://www.bcbsri.com/providers/update/correct-coding-established-vs-new-patient