Question

multiple choice question

a patient who has not received any services from the provider in the past three years is known as a(n) ________ patient.

new
old
established
billable

Explanation:

Define the CPT criteria for patient classification

According to the American Medical Association (AMA) Current Procedural Terminology (CPT) guidelines, a patient's status is classified as either "new" or "established" for billing and documentation purposes. This classification depends on the timeframe of professional services received from the provider or another provider of the exact same specialty and subspecialty within the same group practice.

Analyze the three-year rule

The standard CPT guideline states:

• A new patient is one who has not received any professional services from the physician/practitioner or another physician/practitioner of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
• An established patient is one who has received professional services from the physician/practitioner or another physician/practitioner of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

Evaluate the given scenario and options

The question describes a patient who has not received any services from the provider in the past three years.

• Since the timeframe without services is three years or more, the patient meets the definition of a new patient.
• Let's match this with the provided choices:
• new: Correct, matches the CPT definition.
• old: Incorrect, not a standard medical billing or administrative term.
• established: Incorrect, this would require services within the past three years.
• billable: Incorrect, this refers to whether a service can be billed to insurance, not the patient's relationship status with the provider.

Answer:

• new (Correct answer)
• old
• established
• billable