Wiki New patient office visit with new patient physical/preventive

[wynonna]

For commercial insurance, is it better to have patient come back for an annual PE just after patient presents as a new patient? (for 2 separate visits)
In other words, when a patient moves to a new area, and they are due for a Physical/preventive, is it usual for practices to schedule a new patient visit and have the patient come back another day for their annual?
Or, if they are to be billed together, (regarding non-Medicare only, not Wellness) what are the requirements necessary for the providers to document in order to bill both on same day? (PE-annual and office visit same day billing)
Thank you

 

[Pam Warren]

We have them come back. Technically you can bill both on the same day (one new patient visit and one established patient visit with a -25), but there are problems associated with this. The patient that comes in for preventive care is assuming there is no deductible/coinsurance/co payment responsibility for that preventive care, and so if you add on another 'sick' visit at the same time, you'll be battling with the patient about padding the bill (been there, done that). Sometimes the payers simply won't pay both, and you have to adjust off one of the visits as provider responsibility. And in some cases, like Medicare, preventive visits from the 99381-99396 aren't covered, and your MAC will adjust the amount of the E&M from the amount of the PE and you'll have to balance bill the patient.

So we advise our front desk people to ask the new patient if they have a problem, and we usually schedule that first.

 

[jhendrix08]

Agreed. We always schedule these as two separate visits. Mostly because our new patient visits are longer and our providers schedules don't allow for both to be done on the same day but there is also the concern with getting both paid. So, best bet is to schedule them separate and just explain this to the patient ahead of time. Our new patients are always told up front that their Physical will be done at a different appt; if they ask. Hope that's helpful.