Wiki Urgent Care E/M

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okathy

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How do I determine if a patient is New or Established when billing for professional services. Our urgent care is owned by a hospital, as well as, primary care offices & pediatrics. I've been told that if a patient comes into the urgent care for the first time, but has been seen in our primary care office, then the patient is established. Is this correct?
 
kbales

That is correct. I work for an office that is owned by hospital. Anytime a patient was seen by another provider under the same tax ID, which is what happens when you are owned by a hospital, you must bill established or your claim will deny.
 
Isn't Urgent Care a different specialty? Is it recognized as being different from primary care and pediatrics? If not, then you are correct - it would be an established patient since the patient was seen by another provider of the same group and specialty within the last 3 years.
 
So to make sure I understand this correctly, if a patient is seen by any primary care provider, a pediatrician or another provider in any of the 3 urgent care clinics w/in the previous 3 years, that patient is considered to be established?

What if the same patient had outpatient labs or x-rays? This wouldn't make any difference because the patient isn't/hasn't been seen face to face....correct?

Would it make it difference if the patient had been treated in the ER?

Thanks for all your help! I greatly appreciate it!
 
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