new vs established

Pt sees MD for the first time & is self pay.
Next time, pt has insurance. Would we bill this visit as new or established. (established because pt has been seen before or new because never billed insurance)
Thanks

Comments

  • edited May 2017
    Established...has nothing to do with insurance

    Cathy Satkus, CPC
    Harvard Family Physicians
    Tulsa, OK
    918-743-8200
  • You'll bill as new. It really hasn't anything to do with insurance or none, but whether the patient has been seen by your provider (or another provider in the same group and same specialty), in the last three years.

    Hope this helps.

    Kris

    Kris Cuddy, CPC, CIMC
    Healthcare Compliance Analyst
    Compliance Office
    Michigan State University HealthTeam
    East Lansing, MI
    Ofc: 517-355-4547
    Fax: 517-353-5292

  • Kris,

    I think you meant to say ESTABLISHED! It has nothing to do with insurance or cash pay. If the patient has had a face-to-face encounter with the provider within the past 3 years, they are established.

    Karl Ellzey
    Ellzey Coding Solutions, Inc.
  • I most certainly did mean to say established!! Thank you Karl for catching that!!

    Kris

    Kris Cuddy, CPC, CIMC
    Healthcare Compliance Analyst
    Compliance Office
    Michigan State University HealthTeam
    East Lansing, MI
    Ofc: 517-355-4547
    Fax: 517-353-5292


  • That’s sort of an ethical type situation; is he seeing him for the same problem? I think I would say b ill established because if they just got this insurance then they may get hit with a deductible and when they receive their eob they may look at it and say I was not a new patient!
    :) just my two cents.

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    AHIMA ICD10 PROFICIENT
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor
    858-499-4382


  • ESTABLISHED


    Mindy L Dowd CPC,CPMA
    Denver Arthritis Clinic
    200 Spruce St
    Suite 100
    Denver,CO 80230
    (303)302-7433
    mdowd@dacdenver.com

  • :)

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    AHIMA ICD10 PROFICIENT
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor
    858-499-4382


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