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New pt vs established pt and tax id #

  1. #1
    Wink New pt vs established pt and tax id #
    Exam Training Packages
    i AM LOOKING FOR SOME DOCUMENTATION TO SUPPORT THAT A PROVIDER WHO MOVES TO A NEW LOCATION AND GETS A NEW TAX ID # CANNOT BILL ESTABLISHED PATIENTS A NEW PATIENT VISIT. ESPECIALLY SINCE THEY HAVE SEEN MANY OF THESE PATIENTS JUST A FEW MONTHS PRIOR.

    THANK YOU
    JOYCE

  2. #2
    Location
    North Carolina
    Posts
    3,126
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    Ohhh...have I been down this road!

    When you change practices

    Consider this scenario: Suppose you leave the practice where you have been working for a number of years to join a new group in a nearby community. Some of your patients transfer their care to the new practice and see you within three years of their last visits. You would report these encounters using an established patient code because, although you are practicing in a new group, you have provided professional services to the patient during the last three years. Note that whether the patient has transferred his or her medical records to your office and how long you may have had those records is irrelevant. The amount of time that's passed since your last encounter with the patient is the determining factor.

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

  3. #3
    Default
    I can refer you to your CPT book to the definition of a new patient. We had a pediatrician leave an established practice, and join our newly established practice as a solo practitioner, many of her patients followed. and since she had previously seen them at her old practice, within 3 years, they are considered established patients. Just because they are "new to the tax ID" doesn't mean they are "new to the practitioner" They are established.

    Let me add to this... make sure the patient who "follows" brings their old records!!! I have seen many of times where the provider forgets their established, bills new patient, insurance kicks it back. and also they'd have to start from scratch with the documentation....it just makes it easier with the records. so, when an appointment is scheduled make sure the receptionist asks something like, "have you EVER seen this Dr.." "be sure to bring your old records" or something along those lines... because it sounds like if the patients are following, the physician is still within the area of the other practice, and from experience, the "other practice" isn't always so "kind" in sending records as a courtesy.
    Last edited by ARCPC9491; 03-31-2009 at 09:50 AM.

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