# New Physician/New Practice - Established Physicians?



## Love Coding! (Jun 26, 2013)

Ok, so you have a new physician starting with a new practice with patients that are following him/her to that new practice. What are they considered once they see one of the original established physicians? Would they still be considered "established" or "new" since they have never seen these physicians before at that particular practice?


P.S. I have posted this question on another thread, but thought I would get more exposure creating my own thread.  I apologize for the duplicity..


Thanks so much!


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## tbramhall (Jun 26, 2013)

If the patients have not seen the provider in three years then they are new; but if the provider as seen the patients face to face in the last three years not matter where then established.


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## Love Coding! (Jun 26, 2013)

tbramhall said:


> If the patients have not seen the provider in three years then they are new; but if the provider as seen the patients face to face in the last three years not matter where then established.



Hi,

Let me try to rephrase this I apologize for not being clear.  We have a new physician starting with our practice.  He is having his patients follow to our practice.  By chance if one of our other physicians that have been here for years were to see those patients as well, at that point in time would the patient be "new" because OUR physicians have never seen this patient before?  I hope this make it easier to understand...


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## tbramhall (Jun 26, 2013)

It would have to be an established patient because the patient was seen by a physician within the past three years of the same specialty. It doesn't matter that it was at a different practice previously, the definition is " one who has received professional services from the physician, or another physician of the same specialty who belongs to the same practice."   So your (OUR) physicians is consider the " another physician of the same specialty".  Hope this helps.


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## Love Coding! (Jun 26, 2013)

*Let's try this again*



tbramhall said:


> It would have to be an established patient because the patient was seen by a physician within the past three years of the same specialty. It doesn't matter that it was at a different practice previously, the definition is " one who has received professional services from the physician, or another physician of the same specialty who belongs to the same practice."   So your (OUR) physicians is consider the " another physician of the same specialty".  Hope this helps.



Ok, read this below and tell me if you agree with this or not...thank you

"The patient's that are following our new physician Dr. XYZ (from his previous office) are NEW to our practice (ABC Clinic) but not NEW to Dr. XYZ. Since he knows these patients, we do not bill a new patient visit when he sees them.  If these patients were to see one of the ABC Clinic physicians that have been here for years, we would bill a new patient visit because they are new to that physician AND new to the practice."

Anyone?


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## Pam Brooks (Jun 27, 2013)

That's correct.


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## Love Coding! (Jun 27, 2013)

Pam Brooks said:


> That's correct.



Thanks Pam!


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## Love Coding! (Jun 27, 2013)

Love Coding! said:


> Thanks Pam!



From:

http://www.wpsmedicare.com/part_b/resources/provider_types/2009_0727_newpatientservices.shtml


Q10. Doctor A is new to our group. If a former patient sees Doctor A under our group, is this patient new or established? If the former patient has a visit with Doctor B, in our group with the same specialty as Doctor A, is the patient new or established?

A10. If Doctor A sees his/her former patient, the service is an established patient visit. Doctor A's NPI shows the provider has seen the patient within the previous three years. If the patient sees Doctor B under the new group with the same specialty without seeing the Doctor A first under the new group, then the patient is considered a new patient because the Tax ID is different.


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