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New vs Establish Office debate

  1. #1
    Default New vs Establish Office debate
    Exam Training Packages
    New Physician to our practice and his patients from his private practice followed him here. Is that a new pt or establish? I said new to this practice....Any responses are appreciated.


    Thanks

  2. #2
    Location
    Ellenville, New York
    Posts
    1,176
    Default New
    We had a similar situation - MD is now billing under our practice NPI, not her individual NPI that she used in private practice, so those patients are new.

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    I disagree.

    A Definition of New Patient for Selection of E/M Visit Code

    Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years.

    Page 48

    https://www.cms.gov/manuals/downloads/clm104c12.pdf


    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/2003/0900/p33.html

  4. Default
    They are ESTABLISHED. It does not matter if it is an "new" practice, this physician has seen them before within the last three years so they are ESTABLISHED.

  5. #5
    Default
    I agree these patients would be established patients not new. The time factor is the deciding factor.

  6. #6
    Location
    Evansville Indiana
    Posts
    451
    Default established
    They would be established patients.
    LeeAnn

  7. #7
    Default
    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 3 years." Changing group practices (ie, tax ID #'s) doesn't change the physician - he's still provided a service within the past 3 years...here's an article from AAFP that explains it:

    "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.

    Visits with patients who do not transfer care and are seen by another family physician in the original group within the three-year time frame are reported as established patient encounters. In this instance, the patient's status is determined by the group identification, the time frame since the last encounter and the specialty of the physician providing care.

    When one group provides coverage for another physician group, the patient encounter is classified as it would have been by the physician who is not available. For example, let's say your practice provides coverage for a solo physician in your community. While the physician is out of town, you see one of her patients. As long as the physician who is out of town has seen the patient in the last three years, you have to report the service using an established patient code. This is true even if you are unfamiliar with the patient, clinical information is not available and the office staff does not have basic demographic information."
    http://www.aafp.org/fpm/2003/0900/p33.html

    Now what I would want to know is, let's say that this doctor (We'll call him Dr. X) had seen a patient at his old practice right before coming to the new practice; if the patient sees another provider in the office instead of Dr. X on their initial visit to the new practice, would it still be considered established, or would it then be able to be new? Technically, the patient wouldn't have received any professional services from another provider within the same group practice in the past 3 years, since the only services received from Dr. X would have fallen under a different group practice, so I'd think it would be new then...but that's just a guess... (I would like to know the answer, though...)

    Personally, I think that if the doctor changes groups and goes to a new practice, any patients transferred should be considered new; I only think that because the clinic will have to go through all of the usual work for a new patient; gathering histories, setting up an account, verifying everything, getting signatures, and whatnot. It seems to me like all of the cost for that extra work is incorporated into the RVU for a new patient visit, so if a doctor changes practices, he's kind of getting screwed out of recouping that revenue. But, I don't write the rules, I just follow them...

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