Okay, I visited with my primary doctor and was billed a new patient fee. He sends me to physical therapy located in the clinic, and they billed for me also for a new patient. After that visit, I go to the chiropractor at the clinic and is billed again for a new patient. In fact, the list going on as I was also billed 3 more times in a single day other services. Is this feasible?
It is like going to the lab to have blood drawn or the x-ray department, and getting billed for coming to the lab and/or x-ray as a new patient, and still having to pay extra for the blood test and/or x-ray.
Thanks for your quick response. The way the medical center has it set-up, they are private practices working with the doctor. Do you have any information that I can use to go after them for charging me these bogus fees? Thanks
I'm not sure what was told to you, but my opinion is, and this may depend on the insurance as well, if you have never seen that provider in the last 3 years, or anyone in that particular specialty, then yes, I believe they can bill it as new patient visits.
If these providers are not within the same practice, then yes, they can bill you as a new patient. As far as the lab/x-ray - there are no E/M codes associated with lab/x-ray so you won't have higher fees due to being a new patient.
What about this scenario: patient goes to Urgent Care, since their primary provider's office is closed, and is billed as a new patient visit. (The primary care provider and the Urgent Care provider are employed by the same physician group.) Would the patient be new or established?
Urgent Care codes use 99201-99215. If you have never seen the Urgent care provider and he is not in the same specialty as your primary provider, you would be considered a new patient.
See below CMS guidelines:
Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years. For example, if a professional component of a previous procedure is billed in a 3-year time-period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient. Beginning in 2012, the AMA CPT® instructions for billing new patient visits include physicians in the same specialty and subspecialty. However, for Medicare E/M services the same specialty is determined by the physician's or practitioner's primary specialty enrollment in Medicare. Recognized Medicare specialties can be found in the Medicare Claims Processing Manual, chapter 26 (http://www.cms.gov/manuals/downloads/clm104c26.pdf). You may contact your Medicare claims processing contractor to confirm your primary Medicare specialty designation.
I sorry I have to disagree. Under the E/M service guidelines 2016 Standard CPT® current procedural terminology book there is a chart page two of the guidelines. "Decision tree for New vs Est pt. bottom line of this chart
If "Same specialty" not new patient
If not "Exact same subspeciality" this is a new patient