|Q:||Two years ago, I saw Mrs. Jones as a new patient. I took a detailed history and developed a treatment plan for her HTN, CAD and other health issues. My office has attempted to schedule additional appointments and Mrs. Jones is either a no-show or cancels the appointment at the last minute. Mrs. Jones had a recent hospital stay where CHF and valvular heart disease were diagnosed. I haven’t seen her in two years and she has come to my office to continue outpatient treatment. I basically have to start from scratch due to her long absence and new health problems. Can’t I bill her visit as a new patient?|
The answer is no.
Mrs. Jones may be a noncompliant patient, but she is an established noncompliant patient. CMS guidelines specifically define a new patient as someone who has not received services from this physician or another physician in the same group during the past three years. Because Mrs. Jones last saw this clinician two years ago, she meets the criteria for an established patient.