Wiki New patient vs Established patient

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Twright

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Good morning!

Could someone please help me? We have an NP that is transferring to our facility and some of her previous patients are transferring to her care as well...we are a multi-specialty group practice. Some of these patients are new to our practice, but not new to her care, are these patients considered new or establishing? If establishing could you please direct me where I get this information?

Thanks you
Teri W. CPC
 
They would be considered established patients. For example: if you are billing lets say Medicare patients as new patients of this NP at your practice, Medicare will have a trail of her NPI/Name being billed as the provider for the beneficiary from previous dates of service.
 
The E/M guidelines actually doesn't come out and address the situation of a provider leaving one group practice and going to another w/patients transferring to the new facility to continue care of the original provider. Could you please direct me to this information, or if there is other information available?


Thanks
Teri W. CPC
 
The AMA says that a patient is established if they have received professional services from the provider or another provider of the same specialty and group practice within the past three years. That's it. End of story. The don't have to say no exceptions due to place of service, NPI, TIN, phase of the moon, the Bull's standing in the playoffs, paper or plastic, soup or salad, black or white, etc. because no exceptions exist.

It's like training my dog. If I don't want him to bark unless someone is on our property, then I tell him, “Don't bark unless someone is on our property” (let's pretend he listens to me). I've given him a command with a relevant exception. If I tell him, “Don't eat my shoes,” I mean…don't eat my shoes, no exceptions. I don't have to say, don't eat my red shoes, don't eat my shoes if it's Monday, don't eat my shoes if you're mad, don't eat my shoes in the house, etc. I just have to say ‘don't eat my shoes' because that is the whole story, no exceptions.

I don't know that you'll find anything more concrete from a carrier. I just did a quick search of CPT Assistant and Margie says the same thing over and over which is just reciting the CPT definition. Here are some other sources that say the same thing.

http://www.aafp.org/fpm/2003/0900/p33.html

http://alleviant.com/our-thinking/new-vs-established-em-patients/

http://www.texmed.org/Template.aspx?id=5768

http://codapedia.com/article_55_New-Patient.cfm

http://www.supercoder.com/coding-ne...ne-new-vs.-established-patient-status-article
 
camillecoder@hotmail.com said:
The AMA says that a patient is established if they have received professional services from the provider or another provider of the same specialty and group practice within the past three years. That’s it. End of story. The don’t have to say no exceptions due to place of service, NPI, TIN, phase of the moon, the Bull’s standing in the playoffs, paper or plastic, soup or salad, black or white, etc. because no exceptions exist.

It’s like training my dog. If I don’t want him to bark unless someone is on our property, then I tell him, “Don’t bark unless someone is on our property” (let’s pretend he listens to me). I’ve given him a command with a relevant exception. If I tell him, “Don’t eat my shoes,” I mean…don’t eat my shoes, no exceptions. I don’t have to say, don’t eat my red shoes, don’t eat my shoes if it’s Monday, don’t eat my shoes if you’re mad, don’t eat my shoes in the house, etc. I just have to say ‘don’t eat my shoes’ because that is the whole story, no exceptions.

I don’t know that you’ll find anything more concrete from a carrier. I just did a quick search of CPT Assistant and Margie says the same thing over and over which is just reciting the CPT definition. Here are some other sources that say the same thing.

http://www.aafp.org/fpm/2003/0900/p33.html

http://alleviant.com/our-thinking/new-vs-established-em-patients/

http://www.texmed.org/Template.aspx?id=5768

http://codapedia.com/article_55_New-Patient.cfm

http://www.supercoder.com/coding-ne...ne-new-vs.-established-patient-status-article
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This is definitely the age of social media...I just caught myself looking for the "LIKE" button!! :D
 
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