Reader Question:
Condition Doesn't Change Patient Status
Published on Tue Oct 11, 2011
Question: Our office saw a patient six months ago for a certain condition, and sent the patient back to his primary care provider for further treatment. The same patient was recently referred back to us for a different condition. Should we bill that patient as new, since he's coming back for a different reason?New Mexico SubscriberAnswer: This patient should be considered "established" for many reasons. If your physician sees a patient any time within a 36-month period, that patient is considered established, regardless of the reasons for the visits. This is the AMA's "three-year rule." You should go by this rule even if another physician in your practice sees the patient, as long as it's within the 36 months. Location is not a factor either, in the event your practice has more than one location.Why: This rule applies as long as all the physicians in your group bill under the same [...]
