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New Patient OV

  1. #1
    Default New Patient OV
    Medical Coding Books
    Hello fellow coders. I have a situation that I would love some help with.
    I work in a Rheumatology office and one of our doctors just quit. He has a following of patients that are now seeing our other physicians. Can the physician that is now treating the pt charge for a new patient visit when the pt transfers?

    Thank You So Much!!
    Kristin

  2. #2
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    No, these are established patients. They previously saw a physician in the same group practice, same specialty, so are considered established (unless they haven't been seen in three years, which is unlikely in a Rheumatology practice!).
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Default
    For some reason I was thinking they could be considered New Patients. They have definately been seen within 3 years...

  4. #4
    Default
    Thank you for your help Guru!

  5. #5
    Default
    Guru... The company that I work for just merged with a hospital and we have changed tax id #"S and our company name. The physician that quit was not involved in this transition as he was already gone.
    In this case, can I charge a new pt?

  6. #6
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Perhaps someone has an official ruling about this scenario - but here are my thoughts about that - are you going to charge all of your established patients as new the first time you see them under the new tax ID number? The practice I worked for in Dallas was a single physician for a while; she then incorporated as a group (with some NPP's, eventually other physicians) which changed the name of the practice and her TIN. That did not make the patients new.

    You could argue the case for new if none of the other physicians ever, ever saw those patients, or if you didn't have a chart already - but my gut instinct says they are not new patients. This is just my opinion - I can't find anything in writing about this scenario. Others are free to disagree or enlighten me! If there's a source, I'd love to know about it.

    And another thought - I know of a case where an Endocrinologist in independent practice passed away suddenly. His patients, of course needed new doctors ASAP. Our group of Endocrinologists took on a lot of them; his office staff would send over their medical records; and our doctors would not charge new patient visits in this case, as a courtesy to the patients. It was good for the patients, the insurance, and created goodwill toward the group.

    I wish I could be more help - but I just don't have a resource for this particular question.

    Sorry,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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