New Evaluation When Patient Changes Insurance

January 20, 2025
 / 
Rick Gawenda
 / 

As we begin the new year, some of your patients who began therapy prior to January 1, 2025 will have a different insurance for dates of service on and after January 1, 2025. That leads to a frequent question I receive. When a patient switches insurance during an episode of outpatient therapy, is a new evaluation required?

In this article, I will answer the following questions:

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  1. Thanks for this clarification. Does this apply to those billed using a 1500 form or does it apply / also apply to those nursing home residents where billing is on a UB04?

  2. What about for Medicaid policies? Are new evaluations required yearly if a patient switches from one Medicaid insurance to another?