perkins05
Expert
If patient came in and received ear piercing and no OV charged patient paid for service in 2010. Then return for OV in 2011 is that a new patient or establish patient.
Thanks
Thanks
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki New vs Establish
- Thread starter perkins05
- Start date
btadlock1
Guest
One of the new provisions of HITECH (I think), is that if a patient pays for a visit entirely out of pocket, they can choose not to allow the records for that date of service to be disclosed to an insurer, if they want. If they pay completely out of pocket, they can basically control whether or not an insurer knows that the encounter ever happened.
That being said, you should make sure that the patient would be okay with you disclosing his self-paid procedure from 2010 to his insurance, to avoid any legal liability. (I doubt he'd care in this situation, but someone else, with a pre-existing condition, might.) You should consult with your compliance department on how to handle billing a patient's insurance who would not want a self-paid initial encounter disclosed.
Technically, though, this is an established patient. If they received any service that is reportable with a CPT or HCPCS code within the past 3 years from your doctor (or another MD in the same practice w/the same specialty), then they're established.
That being said, you should make sure that the patient would be okay with you disclosing his self-paid procedure from 2010 to his insurance, to avoid any legal liability. (I doubt he'd care in this situation, but someone else, with a pre-existing condition, might.) You should consult with your compliance department on how to handle billing a patient's insurance who would not want a self-paid initial encounter disclosed.
Technically, though, this is an established patient. If they received any service that is reportable with a CPT or HCPCS code within the past 3 years from your doctor (or another MD in the same practice w/the same specialty), then they're established.
perkins05
Expert
Thanks ladies
Our billing system scrubber was kicking it back to us because the patient was not charged a OV in 2010.
Our billing system scrubber was kicking it back to us because the patient was not charged a OV in 2010.