Author Topic: Closing  (Read 1834 times)


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« on: January 25, 2014, 11:12:59 AM »
I'm not sure if you can help me or direct me where to look for info.

DH owns an outpatient PT clinic, which is closing at the end of the month. He got a job at another clinic which he will start on 2/3. He has finished up all of his patients, except one who had a setback. This patient is Medicare. If the patient follows DH to the new clinic, how is this billed? Would he need to do an Evaluation, since its a different facility?

I didn't have much luck finding info on Palmetto's site
Thanks ~ Bren


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Re: Closing
« Reply #1 on: January 25, 2014, 11:54:40 AM »
Depends on the new practice he's joining and his status there.
Linda Walker
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Re: Closing
« Reply #2 on: January 25, 2014, 09:12:32 PM »
It's another out patient physical therapy clinic. He'd be a PT there.
I know they'll deal with all the recredentialling, etc, so they may know. He was asking me if I could find the info out for him before he started there.


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Re: Closing
« Reply #3 on: January 26, 2014, 12:13:44 PM »

If the PT is seeing the patient at another facility that patient is still an established patient according to CPT and Medicare rules. Assuming this is continuing care for the same diagnosis and under the same care plan as when the PT was working at the other practice. Records have to come over to the new practice of course.

If the patient is being seen at another facility and with another PT then I would get another RX from the physician and then this would be a new patient with a new evaluation and a new plan of care.


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Re: Closing
« Reply #4 on: January 26, 2014, 05:47:11 PM »
There was a question similar to this a few months back, but I don't know what search terms to use to bring it up quickly.

When a patient switches facilities, along with the person who has been seeing them, the issue of new patient or not becomes a question of who "owns" the patient.  The answer falls out along the lines of the NPI Number.  In this instance, the PT who saw the patient first also "owned" the patient.  That is, the PT was the owner of the practice, and got paid for the services by using his Type 2 NPI Number (who gets paid).  It sounds like the PT is going to be an employee of the practice he is joining.  The practice will get paid, using their Type 2 NPI Number (who gets paid), while the PT will simply be the person who did the work (Type 1 NPI Number).  Under this scenario, the patient is indeed a "new" patient of the new clinic.  They have never before visited the clinic that is going to get paid for seeing them, regardless of who does the work.

The previous paragraph is provided for contemplation purposes only.  I don't know Physical Therapy and Medicare Care Plans, so perhaps Merry's version is correct in this case.


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Re: Closing
« Reply #5 on: January 26, 2014, 08:04:24 PM »
I went though this a  few years back and here is a news article I read on it.

When you change practices
Consider this scenario: Suppose you leave the practice where you have been working for a number of years to join a new group in a nearby community. Some of your patients transfer their care to the new practice and see you within three years of their last visits. You would report these encounters using an established patient code because, although you are practicing in a new group, you have provided professional services to the patient during the last three years. Note that whether the patient has transferred his or her medical records to your office and how long you may have had those records is irrelevant. The amount of time that’s passed since your last encounter with the patient is the determining factor.

Visits with patients who do not transfer care and are seen by another family physician in the original group within the three-year time frame are reported as established patient encounters. In this instance, the patient’s status is determined by the group identification, the time frame since the last encounter and the specialty of the physician providing care.

When one group provides coverage for another physician group, the patient encounter is classified as it would have been by the physician who is not available. For example, let’s say your practice provides coverage for a solo physician in your community. While the physician is out of town, you see one of her patients. As long as the physician who is out of town has seen the patient in the last three years, you have to report the service using an established patient code. This is true even if you are unfamiliar with the patient, clinical information is not available and the office staff does not have basic demographic information.

Special considerations for Medicare patients
A slightly different approach may be taken when Medicare patients are involved. Medicare has stated that a patient is a new patient if no face-to-face service was reported in the last three years. The group practice and specialty distinctions still apply, but “professional service” is limited to face-to-face encounters. Therefore, if you see a Medicare patient whom you have seen within the last three years, you must report the service using an established patient code. On the other hand, if a lab interpretation is billed but no face-to-face encounter took place, the new patient designation might be appropriate.

Consultations vs. new patient visits
If a patient is sent to you for an opinion or advice, the encounter may be a consultation service rather than a new patient encounter. CPT defines a consultation as “a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source.” For example, if you are asked to see a patient for a pre-operative clearance or for evaluation of a medical problem, the appropriate category might be consultation services. Since the same consultation codes apply to both new and established patients, it is not necessary to apply the new patient definition.

Just make sure you have everyone sign medical records release. 
I hope it helps.