Front Desk Patient Service Representative / Medical Patient Access (PSR/MPA) Training Practice Test 2025 - Free PSR/MPA Practice Questions and Study Guide

To determine whether a patient is considered established or new, verification of prior visits to the same specialty area is crucial. An established patient is someone who has received services from a healthcare provider within a certain timeframe, typically three years, and this often applies to the same specialty area. This distinction impacts how the provider bills the insurance and the coding for services delivered.

When a patient has been seen before in the specific specialty area, it indicates their existing relationship with the healthcare provider, which is a key factor in defining their status. Establishing this relationship is significant for continuity of care and for the proper management of medical records.

While reviewing medical records could provide context about the patient's history, it does not confirm their established status without a connection to prior visits in the same specialty. Similarly, checking insurance coverage or confirming financial status, while important administrative tasks, do not determine the patient’s classification as established or new in the context of their interaction history with the healthcare system.