New Patient Established Patient: Fill & Download for Free

Here is what we get paid for office visits:2018 Medicare Physician Fee Schedule:99201 New patient office visit, Level 1 $44.5099202 New patient office visit, Level 2 $75.73999203 New patient office visit, Level 3 $109.4699204 New patient office visit, Level 4$ 166.1699205 New patient office visit, Level 5 $ 209.23 (60 min or extreme complexity)99211 Established patient office visit, Level 1 $20.4699212 Established patient office visit, Level 2 $44.1499213 Established patient office visit, Level 3 $73.93 (the 15 minute visit)99214 Established patient office visit, Level 4 $108.74 (the 30 minute visit)99215 Established patient office visit, Level 5 $146.43 (45 min or extreme complexity)So the majority of doctor visits are level 3 or 4, and most are “established” patients for primary care.The average “overhead” percentage for primary care is 60%.Let’s say you do 4 of the 15 minute visits per hour for eight hours, or 32 patients per day. That is $2,365.76. Then 60% of that is $1,419.46. This will leave $946.30 per day, or $118.29 per hour in wages for the doctor, but that would assume that you do not get any health insurance, benefits, or anything like that. Also, there are typically going to be 2–4 hours of unpaid time answering the phone, looking at lab tests, refilling prescriptions, typing up charts, and etcetera.“A 2012 article in the Annals of Family Medicine noted that the average primary-care physician has about 2,300 patients on his "panel"— that is, the total under his or her care. Worse, it said that each physician would have to "spend 21.7 hours per day to provide all recommended acute, chronic and preventive care for a panel of 2,500 patients." -This quotation comes from an article in the Washington Post. It suggests that doctors should NOT see more than 19 patients per day.I PAID MY LAWYER $100 FOR THE 15 MINUTES IT TOOK FOR HER TO CALCULATE MY BILL. That is no lie. SHE WENT TO SCHOOL FOR 3 YEARS AFTER COLLEGE. I was in training for NINE years after college. Hmm.

New Patient Evaluation and Management are ALWAYS much more comprehensive, and therefore yes, costly. The first time a physician sees a patient, they know nothing about them. They have a plethora of intake forms, personal medical history, family medical history, presenting complaints, visual assessment, etc that they must pour through in order to get this first ‘snapshot’ of who is sitting in front of them. What is their lifestyle and how does it affect their health? What is their family and psychological history? What surgeries, major illnesses or hospitalizations have they had to undergo?It’s much simpler once all that info has been assembled into a chart and the Dr gets to know you. It takes a great deal more time, on the average, to consult with a New Patient.They can do this because it is not only legal but REQUIRED by law. There are codes specific to New Patients that go on an insurance claim. If an insurance company gets a claim for a patient, from a provider they’ve never seen before, and the claim form has an ‘Established patient’ service code on it, guess what happens? Ya. The insurance kicks it back and says, ‘Wait a minute. We’ve never seen a claim for this patient from this provider. It should be a New Patient visit’. Denied. To code an established patient service, which costs less, is called ‘downcoding’. It’s illegal.So I hope that this answers your question from both a logical and legal standpoint. From here on, your bill won’t say ‘new’.

In Los Angeles, many doctors are booked for a month or more in advance. If you are not an established patient, you will almost certainly not be seen before the first available appointment. Most insurance plans only allow you to see a specific subset of doctors, so if none of them are taking new patients or seeing patients quickly, you have no option for expedited care.If you are in significant pain, or think that your problem might develop into a real emergency, or you know that you need imaging scans to find out the real severity of your problem, you are basically stuck with the ER if you want treatment before a month or two for your problem.This is a common big-city problem that I have personally observed.