New v. Est patient

tracyread

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Insurance is denying for the following scenario:

Patient sees Dr. B in 2015 while Dr. B is affiliated with XYZ clinic.
XYZ clinic is taken over by ABC clinic in 2016, and Dr. B stays on. He sees the same patient at the “new” clinic, in 2016.

New or established? We are billing as new and that’s how I’m reading CPT.

Thank you!
 

LWhitney

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NEW or establised

Insurance is denying for the following scenario:

Patient sees Dr. B in 2015 while Dr. B is affiliated with XYZ clinic.
XYZ clinic is taken over by ABC clinic in 2016, and Dr. B stays on. He sees the same patient at the “new” clinic, in 2016.

New or established? We are billing as new and that’s how I’m reading CPT.

Thank you!


You can only bill as a new patient if the patient has not been seen by the physician or an affiliated physician within the last 3 years.
 
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The only way a patient would be "new" is if a provider, other than Dr. B, sees the patient first.
 
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