Wiki Established Pt vs New Patient

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dmccullers

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Question....If a patient was seen in the hospital as a new patient for a consult or procedure and the patient comes to our clinic for a hospital follow-up...is that considered a new patient (because they have never been to our clinic) or an established patient?

If it is considered an established patient would our physician assisant be able to see them for the hospital follow-up or would the physician have to do that appointment?
 
The patient would be established. The definition of a new patient is one who has not received any face-to-face services by the physician in a three year period. Depending on the insurance the PA could see the patient in the office for the first visit, but you could not bill incident to unless the physician has established a treatment plan for this patient
 
trthel

In my example the provider worked in the ER at the hospital and saw the patient there and the hospital did the billing two years ago.

And now the provider owns their own facility and the patient now sees the provider there.

Insurance Medicare denied stating provider can not bill as a new patient at the clinic because patient was seen within the three years by this provider when the provider worked there at the hospital two years ago.

So the New vs Established has nothing to do with NPI#'S or Tax id#"s just the specialty of the provider correct? I always thought it had to do with the Tax id#'s.

The provider needs to bill the service as a established patient? Is this correct?

Thank you for any help
 
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