Tips from Paula: New Patient Visits

I have had many calls lately from patients who are questioning charges for what they thought was a routine physical.  As we know, under the Affordable Care Act (ACA), routine physicals are covered in full, as long as they are coded as such.

Therefore, if someone books a routine exam with a new (to them) physician, they are assuming this will be paid in full under the ACA. However, many doctors are starting to add a separate code for the “new patient visit”.  This is because these types of appointments tend to take a little longer than a routine exam, in that the physician is getting to know the patient, the family history, medical background, etc.  The new patient visits are a separate code from the annual exam, and will usually be applied to the member’s deductible, pulling cost sharing for the patient.

If one is booking a routine exam with a new physician, they should be prepared to possibly receive a separate bill for those services, unless their out of pocket charges for the year have been met.