Wiki Outpatient Clinics

[KaylaRieken]

Our providers see patients at "outreach" clinics that are based in the hospital. They are considered outpatient services. Can provider bill a new patient visit if we have never seen the patient, but the facility (hospital) has? The facility is telling us we can only charge established because they have seen the patient before.

 

[sls314]

Our providers see patients at "outreach" clinics that are based in the hospital. They are considered outpatient services. Can provider bill a new patient visit if we have never seen the patient, but the facility (hospital) has? The facility is telling us we can only charge established because they have seen the patient before.

If the patient has been seen by a provider of the same specialty within the same group within the last 3 years, you'd bill as an established patient.

The Noridian website has a good explanation with examples:

https://med.noridianmedicare.com/web/jeb/specialties/em/new-vs-established-patient