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How to Complete New Patient Forms

Each new patient or their caregiver will need to complete our 'New Patient Packet' as is standard for all medical practices. The packet may be completed and submitted online following the provided instructions below. 

If you have any difficulty or require further assistance, please feel free to CONTACT US HERE

New Patient Health History: This form requires an overview of your current medical status as well as a detailed medical history. It will be helpful to have relevant information on hand to assist with completing this form. This information should include: Name, Date of Birth, Contact Info, Emergency Contact, Current Doctor's Contact Info, Medical Conditions, Allergies, Family Medical History, Immunizations and Specialist Contact Info. At the end of the form you will be asked to upload a picture of the patient's insurance card. 

Medical Release Form: This form is brief and allows Seniority to communicate with your other medical providers as needed. Please read through all forms carefully prior to signing. 

Consent Form: This form is brief and allows Seniority to treat you or your loved one as a patient. Please read through all forms carefully prior to signing. 

Patient Portal Registry + Access

Please use THIS LINK to access the login page for Patient Fusion


Billing Information

The Seniority Healthcare Care Model utilizes multiple Center for Medicare/Medicaid Services programs to make more resources available to our at risk patient population.  These included Evaluation and Management codes (E/M), Chronic Care Management (CCM) codes, and Collaborative Care Management (CoCM) codes.  They were all created by CMS to enhance primary and psychiatric care for their beneficiaries.  

  • E/M are the codes billed for when a patient is seen in person by the Nurse Practitioner, Physician Assistant, or Physician and is billed under their National Provider Identifier (NPI).  We typically see our patients on a monthly basis.  This is because our patients tend to be significantly debilitated and there are studies that show this practice decreases hospitalizations by a factor of 3 for this cohort.


  • CCM is a program that was initiated in 2015 and has continuously been enhanced by CMS since. This allows practices to bill for non face to face services.  Examples of these services include: prescription refills, coordination with other specialists, coordination with other members of the care team (Senior Living Staff, Physical Therapy, Occupational Therapy, Skilled Nursing, Hospice, etc.), completion of required forms for compliance, prior authorizations, after hours on call coverage, urgent care needs, etc.  This is a very abbreviated list of the actual activities that take place.  These services are billed on a monthly basis and reflect the cumulative time spent during that month.  Seniority Healthcare keeps a ledger of the amount of time spent and the activities that took place.  The insurance is then billed based on time as allowed by CMS.  This amount varies month to month based on the amount of time spent by our Care Coordinator staff involving the patient's care.  This is all documented as per CMS rules and regulations.  CMS requires CCM to be billed under the Supervising Physician's NPI.

  • CoCM is a program that was launched in 2017 to integrate behavioral health with primary care.  The initiative was started after years of research out of the AIMS Center in Washington State proved that integrating psychiatric and primary care provided better overall outcomes for those suffering from chronic medical and psychiatric disease. Seniority Healthcare uses Behavioral Health Care Managers (BHCMs) to ensure our patients with cognitive and psychiatric disease are properly integrated with our primary care service.  We work in environments where our psychiatric team treats patients as well as outside service providers.  It is exceptionally important to employ this program in environments in which we are not the psychiatric care provider.  This is because the care is being provided by two different organizations and coordination of care can be more challenging in this setting. Like CCM, CoCM services are billed on a monthly basis and reflect the cumulative time spent during that month.  Seniority Healthcare keeps a ledger of the amount of time spent and the activities that took place.  The insurance is then billed based on time as allowed by CMS.  This amount varies month to month based on the amount of time spent by our BHCM staff involved in the patient's care.  This is all documented as per CMS rules and regulations.  CMS requires CoCM to be billed under the Supervising Physician's NPI.

As you can see and have experienced, Medicare billing requirements can cause confusion.  However, these are Medicare initiatives to reduce hospitalizations, increase access to care, and improve care coordination.  They take a tremendous infrastructure to execute and implement and therefore the capital resources they provide allows us to be adequately staffed.   When patient's or POAs consent to our services they are consenting to being entered into these programs if medically appropriate.  This is stated explicitly on our consent forms.


All Medicare programs are subject to cost sharing as per the beneficiaries insurance choice.  We cannot predict who will have cost sharing as this is up to their insurance provider.  I have stated in the past, those with traditional Medicare with supplemental insurance should have no out of pocket expense except their annual deductible which is required for all Medicare beneficiaries and is set by the agency.  In the event that a patient cannot afford their cost sharing due to financial hardship Seniority Healthcare will waive these fees once hardship is verified.  It is a violation of CMS compliance to waive it unless the hardship exists.  


Under federal law, your patient health information is protected and confidential. Patient health information includes information about your symptoms, test results, diagnosis, treatment, and related medical information. Your health information also includes payment, billing, and insurance information.       We use health information about you for treatment, to obtain payment, and for health care operations, including administrative purposes and evaluation of the quality of care that you receive. Under some circumstances, we may be required to use or disclose the information even without your permission.       We will use and disclose your health information to provide you with medical treatment or services. For example, nurses, physicians, and other members of your treatment team will record information in your record and use it to determine the most appropriate course of care. We may also disclose the information to other health care providers who are participating in your treatment, to pharmacists who are filling your prescriptions, and to family members who are helping with your care.       We will use and disclose your health information for payment purposes. For example, we may need to obtain authorization from your insurance company before providing certain types of treatment. We will submit bills and maintain records of payments from your health plan.       We will use and disclose your health information to conduct our standard internal operations, including proper administration of records, evaluation of the quality of treatment, and to assess the care and outcomes of your case and others like it.        We may use your information to contact you with appointment reminders. We may also contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.       We may use or disclose identifiable health information about you for other reasons, even without your consent. Subject to certain requirements, we are permitted to give out health information without your permission for the following purposes:            -We may be required by law to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.            -We may use or disclose information for approved medical research. As required by law, we may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.       We may be required to disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.       We may disclose information in response to an appropriate subpoena or court order.       Subject to certain restrictions, we may disclose information required by law enforcement officials.       We may report information regarding deaths to coroners, medical examiners, funeral directors, and organ donation agencies.       We may use and disclose information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Military and Special Government  If you are a member of the armed forces, we may release information as required by military command authorities. We may also disclose information to correctional institutions or for national security purposes.       We may release information about you for worker's compensation or similar programs providing benefits for work related injuries or illness.        In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.       You have the following rights regarding your health information:       You may request restrictions on certain uses and disclosures of your health information. We are not required to agree to such restrictions, but if we do agree, we must abide by those restrictions.       Also, if you have paid for your health care treatment out-of-pocket and in full, and if you request that we limit disclosure of your information to a health plan for purposes of payment or health care operations, we will abide by your request.       You may ask us to communicate with you confidentially by, for example, sending notices to a special address or not using postcards to remind you of appointments.       In most cases, you have the right to look at or get a copy of your health information. There may be a small charge for the copies.       If you believe that information in your record is incorrect, or if important information is missing,  you have the right to request that we correct the existing information or add the missing information.      You may request a list of instances where we have disclosed health information about you for reasons other than treatment, payment, or health care operations.       We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect.       We may change our policies at any time. You can also request a copy of our Notice at any time.  If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about your records, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below will provide you with the appropriate address upon request. You will not be penalized in any way for filing a complaint.  If you have any questions, requests, or complaints, please contact:  Lisa Nichols  Director of Operations  P.O. Box 159  Barrington, NJ 08007  888-982-8594

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