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New vs Est Patient

  1. #1
    Kalamazoo, MI
    Unhappy New vs Est Patient
    Medical Coding Books
    I work for a small hospital that has many specialty clinic offices ranging from family practice to OB/GYN to Orthopedics, etc. I have been told that all the clinics, including the hospital bill under the same tax id number and because of this if a patient is seen in the OB/GYN and then goes to see the Orthopedic provider for the first time, that patient would be Established because of being established in the OB/GYN office and being seen there within the last three years.

    I always thought that specialty separated the decision of new vs. est, but the hospital does not agree. Can anyone give me any insight on this? The hospital is saying the price difference between a new vs est is not very much so they just rather do it this way to make it simple and easy for everyone.

    Any insight would be much appreciated!

  2. #2
    Milwaukee WI
    Default You are correct
    You are correct that the distinction is divided by recognized specialties, so the patient who was seen by OB/GYN in February, would still be a established patient ONLY to that specialty. If that same patient came in with a broken ankle in June, she would be a NEW patient to ORTHO (assuming she hadn't seen an Ortho doc in that practice during the past three years).

    I understand the hospital staff saying it is easier to just use the larger tax ID umbrella, but they are leaving money on the table by doing so.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Kalamazoo, MI
    Thank you, that does help. The hospital's arguement is that there is only a $1.00 price difference between the new and established code that the provider would bill out.

    Thanks again!

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