PSarbu
New
Physician has hospital inpatient visit with patient. The patient later transfers to nursing home and the same physician sees patient there. Is the nursing home visit considered a new patient or established?
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Wiki New vs. established patient
- Thread starter PSarbu
- Start date
Pathos
Guest
Hello,
A patient's status is not based upon the Place of Service location, rather the provider type, specialty and practice. If the patient was seen by a provider in the hospital, and then seen again by the same provider later in a nursing home, the nursing home visit would be considered an Established Patient SNF visit.
Here is some references from my local MAC (Noridian):
"New Patient
Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g., surgical procedure) from the same physician or physician group practice (same physician specialty and subspecialty) within the previous 3 years.
Established Patient
Individual who has received any professional services, E/M service or other face-to-face service (e.g., surgical procedure) from this provider or another provider (same specialty or subspecialty) in the same group practice within the previous three years."
Noridian - New vs. Established
Hope this helps!
A patient's status is not based upon the Place of Service location, rather the provider type, specialty and practice. If the patient was seen by a provider in the hospital, and then seen again by the same provider later in a nursing home, the nursing home visit would be considered an Established Patient SNF visit.
Here is some references from my local MAC (Noridian):
"New Patient
Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g., surgical procedure) from the same physician or physician group practice (same physician specialty and subspecialty) within the previous 3 years.
Established Patient
Individual who has received any professional services, E/M service or other face-to-face service (e.g., surgical procedure) from this provider or another provider (same specialty or subspecialty) in the same group practice within the previous three years."
Noridian - New vs. Established
Hope this helps!