Wiki new vs established

[newfiegirl]

Hi: We (provider) are trying to get some clarification. If an established patient leaves practice and returns in 6 months and sees a new provider within the same practice is the patient considered new or established? Our thoughts are established because of the 3 year guidelines. Thanks

 

[Pathos]

If the provider who is seeing the patient is of the same credentialing (FM/IM/Cardio, etc) who has been seeing the patient before, and within the 3 year threshold then the patient is considered "Established". However, if the practice is a large provider practice and has IM and FM providers (each credentialed as IM or FM providers), then those are each different specialties and is handled as such. So your answer will depend on the provider who is seeing the patient again. It doesn't matter if the patient leaves the practice and then returns at a later time. It all boils down to how the provider is credentialed at the time of the encounter.

For example, patient John Smith sees Dr. Internal Medicine on 5/4/2018, and then returns to see Dr. Family Medicine on 7/1/2019. The patient is considered a "New Patient" for each visit because the doctors have different specialties. If John was to see Dr. Internal Medicine on 7/1/2019, instead of Dr. Family Medicine then the regular New vs. Established rules apply, and John is then considered an "Established" patient.

Here is some good reading from my local MAC on the subject:

Noridian: New vs. Established

Hope that helps.