Wiki New vs established patient

[ivygirl18@hotmail.com]

Two providers were in a group together. One provider retired and the other provider joined our practice. The office was closed. We have all of the practices patient's charts. The provider is seeing her patients at our practice and billing them as established patients. They are also seeing the retired provider's patients but billing them as new patients. Questioning new vs established in this scenario. Any written documentation?

Thank you,

Abby

 

[williafm]

Q10. Doctor A is new to our group. If a former patient sees Doctor A under our group, is this patient new or established? If the former patient has a visit with Doctor B, in our group with the same specialty as Doctor A, is the patient new or established?
A10. If Doctor A sees his/her former patient, the service is an established patient visit. Doctor A's NPI shows the provider has seen the patient within the previous three years. If the patient sees Doctor B under the new group with the same specialty without seeing the Doctor A first under the new group, then the patient is considered a new patient because the Tax ID is different.

hope this helps. it's from WPS Medicare
http://www.wpsmedicare.com/j5macpartb/resources/provider_types