Wiki New vs. Established pts

[JulieCzyzewski]

If you have a new provider join your practice and he sees a pt that he saw at his previous office within the past three years is this a new or established pt? Same specialty for both visits.

 

[ellzeycoding]

This would be an established patient

The rule states that if the physician (or other qualified healthcare provider) performs professional face-to-face services within the past three years, it is an established patient. It doesn't mention where the patient was seen, or the TaxID the services were billed under now or previously.

Usually it's tied/tracked by the rendering provider's NPI number (vs group TaxID). The provider's individual NPI number usually remains the same, even if the change groups or locations.

 

[JulieCzyzewski]

Thank you for your help.