Use three tags in GoHighLevel: New patient, Established patient, and Referred, plus Referred by provider as a field, and let the tags drive messages and calendars. The bottom line: a CRM tag is a workflow label, and whether a visit bills as new or established is decided by the three year rule in the practice system, so the tags must not be used to code a claim.
The three year rule
The American Medical Association's CPT definition says a new patient is one who has not received any professional services from the physician, or another physician of the exact same specialty and subspecialty in the same group practice, within the past three years, and that professional services means face to face services. Medicare's definition in chapter 12, section 30.6.7 of its Claims Processing Manual is similar but uses the same physician specialty, and interpretations differ by payer. The Texas Medical Association notes that a patient could be new to a pelvic medicine specialist under CPT but established under Medicare's definition if a urologist in the same practice saw the patient within three years. An AAFP article adds that a new chart does not make a patient new. So the practice system holds the answer, and the CRM tag mirrors it.
The tag set
| Tag | Meaning | Starts |
|---|---|---|
| New patient | No face to face service in the past 3 years from the practice and specialty | New patient booking calendar and forms workflow |
| Established patient | A face to face service in the past 3 years | Recall and reminder workflows |
| Referred | Came by a referral from another provider | Referral tracking pipeline |
| Lapsed over 3 years | No face to face service for 3 years or more | Treat as new for booking, and confirm with billing |
| Opted out | Asked to stop messages | Removes the contact from messaging |
Keeping the tags accurate
Two things change a patient's status: a visit, and the passage of time. When a visit is completed the practice system updates, and the tag should follow. A patient who has not had a face to face service for three years becomes new again. A workflow can compare the Last visit date field with today and, with Math Operation or a date filter, add Lapsed over 3 years. Confirm the result with the billing lead, since specialties and payers differ.
Build it in GoHighLevel
GoHighLevel's help pages describe tags as labels that start workflows and filter lists, and Smart Lists that use them.
- Create the five tags, and write one line on what each means in an internal note.
- Import the patient status from the practice system when it changes, and let a workflow add or remove the tag.
- Use a Smart List on the date field to find patients with no visit in three years, and have the billing lead review it.
- Show the New patient calendar only to patients tagged New patient or Lapsed over 3 years.
- Route Referred patients into the referral pipeline described in our specialty referral guide.
- Remove conflicting tags when one is added, so a patient does not carry both New patient and Established patient.
Worked example
For example, a practice with 4,000 patients where 5 percent have not had a face to face visit in three years has 200 patients who would be booked as new (4,000 times 0.05). A tag lets the booking page offer them the longer new patient visit, and billing confirms the status.
Mistakes to avoid
- Using the tag to code a claim. The practice system decides.
- Two status tags at once. Remove the old one.
- Ignoring the specialty rule. Status is by exact specialty and group.
- Counting a lab or a phone call as a visit. Only face to face services count.
How this was handled before
Front desk staff checked the chart to see whether a patient was new, and billing applied the three year rule at coding. Tags move part of that decision into scheduling, so the right visit length is offered, while billing remains with the practice system.
What to measure after launch
Track patients with conflicting tags, patients tagged lapsed, and new patient bookings by calendar. Fix any contact with two status tags.
Check before you switch it on
US text messages sent from a standard 10 digit number need A2P 10DLC registration. The HighLevel support portal says registration is required for texts to US recipients from 10 digit long code numbers and that toll free numbers do not require it. HighLevel's opt in guidelines also say a person cannot be forced to agree to text messages in order to submit a form, so keep the consent box optional. One compliance guide separates informational texts, which need documented consent, from marketing texts, which need prior express written consent. Ask your attorney which category your reminders fall into. Have your billing and compliance leads confirm the tag rules against your payers' definitions. This is general information, not legal advice.
Questions people ask
What makes a patient new?
Under CPT, no professional services from the physician or another physician of the exact same specialty and subspecialty in the same group in the past three years.
Is Medicare's definition the same?
It is similar but uses the same physician specialty, so the answer can differ by payer.
Should the CRM tag drive billing?
No. The practice system determines new or established status.
Ready to try it yourself? Start a GoHighLevel account here.
You can also see this in action in our GoHighLevel capabilities demo.