Scenario: A provider buys into an established medical practice. He is, therefore, new to the practice, and he has a different specialty. All patients that he sees there will be new, correct? What if he is from the same specialty as the current provider?
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Wiki New or Established
- Thread starter mprow0002
- Start date
CodingKing
True Blue
If he is same specialty its established.
Pathos
Guest
Hello,
If the patient hasn't been seen by the provider personally, or by another provider with the same specialty and subspecialty within 3 years, then the patient is considered a New Patient. If the reverse is true, then the patient is an Established Patient for billing and coding purposes.
For example:
New provider A is a cardiologist and starts seeing patient. If another provider B from the same practice who is also a cardiologist and has seen provider A's patient before and within 3 years, then -> Established (same specialty).
If the provider is a Nurse Practitioner, then there are some special rules on credentialing, but I'm gathering from your post that the new provider is a physician.
Some references:
AMA CPT 2018 book, New and Established Patient, page 1:
“A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years”.
Noridian (MAC)
Hope that helps!
If the patient hasn't been seen by the provider personally, or by another provider with the same specialty and subspecialty within 3 years, then the patient is considered a New Patient. If the reverse is true, then the patient is an Established Patient for billing and coding purposes.
For example:
New provider A is a cardiologist and starts seeing patient. If another provider B from the same practice who is also a cardiologist and has seen provider A's patient before and within 3 years, then -> Established (same specialty).
If the provider is a Nurse Practitioner, then there are some special rules on credentialing, but I'm gathering from your post that the new provider is a physician.
Some references:
AMA CPT 2018 book, New and Established Patient, page 1:
“A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years”.
Noridian (MAC)
Hope that helps!