Question New vs. established patient

PSarbu

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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?
 

Pathos

True Blue
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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!
 
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