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Am I a new patient if my physician assistant changed locations?

Am I a new patient if my physician assistant changed locations?
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Voting closed: May 24, 2013, 09:28:03 AM

Author Topic: New pt VS. Est pt  (Read 2396 times)

AMBER

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New pt VS. Est pt
« on: May 21, 2013, 09:28:03 AM »
I have a physicians assistant who I have visited several times in the past few years. He left his first practice and decided to join a group facility in a different town. I just went to him for the first time since he moved and was charged a new patient e/m level. I have read a few different articles that conflict one another. Some state if it is the same provider within the last 3 years I would be an established patient regardless of location, others state that since he is in a new facility under a new group it doesnt matter if i was an established pt at his last office, I would be considered new. My bill is over $200 for a 99203. I am a biller and I do not know the answer to this. Any help?

RichardP

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Re: New pt VS. Est pt
« Reply #1 on: May 21, 2013, 11:11:09 AM »
A physician's assistant can bill under their own name and NPI number or they can bill under their supervising physician's name and NPI number.  Do you have any idea whose NPI number the PA was billing your previous visits under?  Do you have any idea whose NPI number the PA billed your recent visit under.

I'm thinking that the who get's paid NPI number would drive the decision of whether you are a new or established patient.  I have not verified that with an authoritative source, but consider the logic of the following layout:

    Older Visits                                   Recent Visit                                   Recent Visit
    Billed under:                                 Billed Under:                                 Classification

         PA       -------------------->              PA       -------------------->     Established Patient
         PA       -------------------->     Supervising Physician (new)              New Patient
Supervising Physician (old)          Supervising Physician (new)              New Patient
Supervising Physician (old)                    PA                                            New Patient


AMBER

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Re: New pt VS. Est pt
« Reply #2 on: May 21, 2013, 01:37:19 PM »
The PA's claims were billed out under the supervising physician at the original location. Now that he has moved they are billing the claims out under the new supervising physician/group NPI.

It would make sense to me if the NPI's were seperate I would be considered a new patient.

Thank you for your help!!

Merry

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Re: New pt VS. Est pt
« Reply #3 on: June 13, 2013, 10:59:02 PM »
If you read the description in the CPT book for new and established patient, it makes no difference that the PA saw you in one place and then another. A new patient is one who has not been seen by that provider in 3 years. I would say established patient. Did the PA bill under the PA's NPI number or under the physician's. I still think that this should be an established patient.

RichardP

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Re: New pt VS. Est pt
« Reply #4 on: June 14, 2013, 10:49:05 AM »
Did the PA bill under the PA's NPI number or under the physician's. I still think that this should be an established patient.

merry - your question was answered by the OP in the post immediately above yours.  The answer made it clear that the OP has switched to a new billing entity.  That would make the OP a new patient.

The PA's claims were billed out under the supervising physician at the original location. Now that he has moved they are billing the claims out under the new supervising physician/group NPI.

Doctor's are free to hire and pay whomever they want - to help them carry out their duties.  The hireling may do the work, but if the doctor is the billing entity (doctor bills under his Type 2 NPI Number), then the patient belongs to the doctor - not to the hireling.  That is, the patient is the patient of the doctor, not the patient of the hireling, even tho the hireling may have done the work.  Think this through in terms of a nurse giving a flu shot:  the patient is still considered the patient of the doctor, even though the nurse (the hireling) did the work.

In the case of the OP, she went from one Type 2 NPI Number (who gets paid) to a new Type 2 NPI Number (who gets paid).  She went from one billing entity to another.  In both instances the doctor was the billing entity, even though the work was done by a hireling.  Thus, the OP is considered the patient of the new doctor / billing entity, not the patient of the hireling.  If the new doctor had not seen the OP before, she would rightly be considered a new patient of his (as the supervising physician), regardless of who did the work.
« Last Edit: June 14, 2013, 11:08:42 AM by RichardP »

Merry

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Re: New pt VS. Est pt
« Reply #5 on: June 14, 2013, 02:08:37 PM »
Sorry Richard. Trying to do some catchup after just getting on.