New problem to different provider in group practice

Post here your questions regarding auditing ,coding, documentation, and compliance. Also, join in on the conversation- help your fellow auditors and compliance professionals in the industry.

Moderators: Shannon DeConda, NAMAS Moderator

Post Reply
JJones
Posts: 44
Joined: Sat Dec 20, 2014 9:32 pm

Tue Nov 19, 2019 12:50 pm

Hello! Thank you in advance for any help you can give.

We are looking for guidance billing for patients who are seen by providers in both a Family Med scenario and a Convenient Care scenario in our practice.

Example: If a patient comes in one day to our Convenient Care practice with a sore throat and sees one of the providers, than in a couple of days comes back to either the same Convenient Care or one of our Family Medicine practices with a worsening sore throat and sees a different provider - is the PROBLEM considered new or established to the next provider? We are trying to correctly established how many points should be awarded. Will this always be considered as a new problem to the new provider (even if in the SAME clinic as previously seen), or would it be an established problem to the provider at any of the clinics associated with our group?

To clarify, our question relates only to the patient's problem, not whether or not the patient is new or established.

Thank you,
JJones
Post Reply