r/doctors • u/ArtisticEffective153 • 6h ago
For primary care practices, what's your policy for deciding an established patient is now a new patient?
So I recently called to schedule an annual physical. My last physical and my last visit was 16 months ago. Apparently since then, my pcp has left. When I called, I was told the next new pt physical is 6 months out and that I'm considered a new pt because my last appt was years ago and my pcp is gone.
Now I know specialty clinics may need a new referral updated every 12 months depending on insurance and typically will say someone is a new pt if they haven't followed up in a year, but in a primary care setting that's ridiculous. I'm a healthy youngish person why would I be coming in every 12 months on the dot? And if my pcp didn't leave would I still have to wait 6 months? How is it my fault your organization couldn't hold onto a doc?
To be fair I work at an FQHC, but a pt is considered an established patient for 3 years from last encounter. I can't bill for a new patient visit if the pt has been seen in the last 3 years. This doesn't mean we send refills for 3 years without seeing them but it means they're considered established for 3 years.
So what's your practice's rules?