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New Patient Vs Established

  1. #1
    Location
    Jacksonville Fl
    Posts
    29
    Default New Patient Vs Established
    Medical Coding Books
    Hi all, I need some clarification on billing "new vs established" when taking over the practice of another physician.

    Scenario:

    Our physician group recently took over the practice of a physician and his 5,000 patient load. The physician practiced under our Tax ID# and was part of our group for only 2 months before moving on with his own new practice.

    This physician is now no longer part of our group and no longer practices under our Tax ID#. Now that our doctors will see this physician's patients and the Dr. is no longer part of our group I would say that we can bill these patients as "new" patients as long as we did not see the patient during the 2 month time frame that this Dr. was part of our group. Any patient seen in that time frame would have to billed as established because a physician in our group saw the patient within 3 years.

    However, any patient we see for the first time outside of that 2 months that the Dr. was in our group we should be able to bill as new.

    Would this be accurate?

    I appreciate any and all input on this just to make sure we are not out of compliance in our interpretation.

    Felicia Owens, CPC

  2. #2
    Default
    Yes I would believe that you can bill the patients that he didn't see in those two months as new. They never were billed using your tax ID # and he is no longer a part of your group. Would like to see how everyone else feels about it.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  3. #3
    Location
    Jacksonville Fl
    Posts
    29
    Default
    Thank you! I am about 98% sure that we are ok,but I hope more respond with input.

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by fowens View Post
    Hi all, I need some clarification on billing "new vs established" when taking over the practice of another physician.

    Scenario:

    Our physician group recently took over the practice of a physician and his 5,000 patient load. The physician practiced under our Tax ID# and was part of our group for only 2 months before moving on with his own new practice.

    This physician is now no longer part of our group and no longer practices under our Tax ID#. Now that our doctors will see this physician's patients and the Dr. is no longer part of our group I would say that we can bill these patients as "new" patients as long as we did not see the patient during the 2 month time frame that this Dr. was part of our group. Any patient seen in that time frame would have to billed as established because a physician in our group saw the patient within 3 years.

    However, any patient we see for the first time outside of that 2 months that the Dr. was in our group we should be able to bill as new.

    Would this be accurate?

    I appreciate any and all input on this just to make sure we are not out of compliance in our interpretation.

    Felicia Owens, CPC
    It is correct that any patient not seen by any provider in your practice within the last three years is a new patient. If the physician who left saw them in your practice during the time he was there, they are established since he was a member of the practice.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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