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3 Year Rule When Billing E&M Visits

  1. Default 3 Year Rule When Billing E&M Visits
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    I put this out last week, but by mistake put my question in the wrong post group so I am going to ask my question again, here goes:

    I have a doctor who was in a practice last October and has since left that practice and has become employed by our local hospital. Since staring his new practice with the hospital we have taken on a new doctor and a NP. Some of my "old" doctors patients from the practice he left last October have started to transfer to his new practice to see him. Here comes my questions:

    #1-Since we are biiling under a completley new TAX ID do I bill these patients as New for the "old" doctor? (regardless of the 3 years rule)

    #2- For the new doctor and the NP who have never seen these patients from the old practice do I bill them as new patients?

    Thanks for any imput anyone may like to give me on this matter.


  2. #2
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    it is my understanding that the three years follows the doctor where ever he goes. if the other providers are part of the same group then they are also not new for those patients that have followed the first provider.
    Debbie Potts England
    Lyles, TN 37098

  3. Default
    Quote Originally Posted by juliejenkins2005 View Post
    I put this out last week, but by mistake put my question in the wrong post group so I am going to ask my question again, here goes:

    I have a doctor who was in a practice last October and has since left that practice and has become employed by our local hospital. Since staring his new practice with the hospital we have taken on a new doctor and a NP. Some of my "old" doctors patients from the practice he left last October have started to transfer to his new practice to see him. Here comes my questions:

    #1-Since we are biiling under a completley new TAX ID do I bill these patients as New for the "old" doctor? (regardless of the 3 years rule)

    #2- For the new doctor and the NP who have never seen these patients from the old practice do I bill them as new patients?

    Thanks for any imput anyone may like to give me on this matter.

    regardless.... they are are billed as established. It does not matter if they are a new practice.... as long as one provider has already seen the patient wherever in the past three years, the patient is billed as established. Hope this helps.

  4. Default
    Well if you read in your 2011 AMA CPT manual it reads"A new patient is one who has not recieved 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."

    So I would think that my new doctor and new NP not coming from the old practice should be able to see these as new patients.

    Thoughts

  5. Default
    Quote Originally Posted by juliejenkins2005 View Post
    Well if you read in your 2011 AMA CPT manual it reads"A new patient is one who has not recieved 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."

    So I would think that my new doctor and new NP not coming from the old practice should be able to see these as new patients.

    Thoughts
    When you have a new doctor coming into the new practice, EVERY SINGLE PATIENT HE HAS SEEN IN THE LAST THREE YEARS is considered established to everybody in the new practice.

  6. Default
    Sorry I do not agree. That new doctor is coming into a new practice and billing under a new tax ID number, I feel that it could be billed as a new patient. I don't feel that he shoud loose out on that new patient visit. That is just thought.

  7. Default
    Quote Originally Posted by juliejenkins2005 View Post
    Sorry I do not agree. That new doctor is coming into a new practice and billing under a new tax ID number, I feel that it could be billed as a new patient. I don't feel that he shoud loose out on that new patient visit. That is just thought.
    It doesn't really matter if you agree or not. The guidelines specifically state that it would be an established patient. If you bill as new then you are fraudulent billing.

  8. #8
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    Quote Originally Posted by eadun2000 View Post
    It doesn't really matter if you agree or not. The guidelines specifically state that it would be an established patient. If you bill as new then you are fraudulent billing.
    It varies by payer and has everything to do with provider numbers and tax ID numbers nothing to do with facts or patient care.
    Mickie Kummer, CPC, CPMA, CRC, CPC-I, AAPC Fellow

  9. #9
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    I work with a hospitalist that left a family practice, and we have to bill patients in the hospital that saw him as a family doctor as established patients. To be a new patient it has to be a completely new patient within 3 years no matter where (if we bill as outpatient).

  10. Default
    Let me add this: Same situation, what happens when the "old doctor" retires and leaves the practice and I still have these patients transferring over from the old practice. We are still in that "3 year period". How would you explain not billing a new patient vist for my new doctor and NP in this new practice?

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