Wiki New vs Established-We are a CAH

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kbarron

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We are a CAH with different specialties. We have a pt that has left the pediatrics practice and transfered to the family practice. I am being told "if it is a like practice pt is not considered new". We are all the same tax id. This pt is NH Medicaid not Medicare. Does anyone have paperwork stating this? I believe that if you transfer from pediatrics to family you are new. I am also being told that if she was seen in the hospital that she is not new. PLEASE HELP!!!!
 
The rules state that as long as the patient is seen for the first time in a different specialty, you can charge for a new patient visit, even if the same tax ID is used, i.e. patient was established with Pediatrics and now is seen for the first time in Family Practice or Internal Medicine.

Hope this clarifies it.
 
you can find it in writing in the CPT 2009 Book(AMA) Professional Edition - page 1 describes it - and page 2 has a Decision Tree on it to help figure out if the patient is "New/Est"
 
In a multispecialty practice, a patient might be considered new even if he or she has received care from several other physicians in the group and a medical record is available. The distinguishing factor here is the specialty designation of the provider. For example, take a patient who has been seen regularly by the pediatrician in your group. The patient is now 18 years old and wants to transfer care to a family physician in the same group. When she sees the family physician, she'll qualify as a new patient because the family physician is in a different specialty than her previous physician. This is the case even though the family physician might be treating her for an existing problem and referring to her established medical record.



http://www.aafp.org/fpm/20030900/33unde.html#Box_D
 
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