Hello. I work for an Urgent Care company, and I have a patient who was in for the first time in November of 2012 for a flu shot. There was no E/M, just the shot. Then she was in for an E/M in July of 2013 for an injury. My question is: does the flu shot make her an established patient, or is she new because she wasn't seen by a provider? Thank you all for your help.
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Wiki Flu shot
- Thread starter bforr
- Start date
mitchellde
True Blue
you had to bill the first claim using the provider NPI number and that then makes the pat established.
MikeEnos
Guest
Deb has a point, if a claim was billed within the last 3 years under that NPI, the insurance may deny the claim...
...HOWEVER, I would recommend you appeal that claim if it denies. A new patient is a patient who “has never received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years." If the Flu shot was administered by an NP, and there was no face-to-face professional service from the doctor, then I would absolutely bill this new service by the doctor as a new patient encounter.
...HOWEVER, I would recommend you appeal that claim if it denies. A new patient is a patient who “has never received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years." If the Flu shot was administered by an NP, and there was no face-to-face professional service from the doctor, then I would absolutely bill this new service by the doctor as a new patient encounter.