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New vs Established patient

  1. Red face New vs Established patient
    Medical Coding Books
    Our 35 year old practice is being "acquired by another". We will be billing with a new tax ID#. The financial guru of the new practice wants to bill every patient as a new patient. Since we will still be in the same facility, same doctors, same staff and same patients, this doesn't seem quite right to me. Does a new tax ID# constitute every patient being new?

    Any input will be welcome. I have already stated my feelings, but no one cares to listen.


  2. #2
    North Carolina
    Rebecca CPC, CPMA, CEMC

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  3. Default
    According to CPT guidelines, face-to-face with the physician in the previous 3 years is the key...not new tax id#. Per CPT "...a new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years."
    Jagadish, CCS-P, CPC

  4. #4
    The patient would be considered established even if it's just a Tax ID change. Only time it can be considered new is if it has been 3 years since their last visit.
    Jessica CPC

  5. #5
    Greeley, Colorado
    I agree with the others. A new tax id# does not change the status of the patient.

  6. #6
    You might want to also look at your carrier manuals for back up-they might also provide guidance.

  7. Default
    Thanks to those that replied re new vs established. She has done this before and assumes she is right. Now, how to approach my soon to be employer without making enemies.

  8. #8
    Greeley, Colorado
    Good luck!

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