3 Steps For Accurate Billing Evaluation and Management Services in Your Practice
Mar25

3 Steps For Accurate Billing Evaluation and Management Services in Your Practice

3 Steps For Accurate Billing Evaluation and Management Services in your Practice Begin by asking questions when determining the accuracy when billing for evaluation and management. Step# 1 – Is the patient seen face-to-face in the last 3 years? The 3-year rule describes that an established patient is someone who was seen by the same physician (or any physician) under a group and of the same specialty or sub-specialty. One good example is: A patient with a chronic back pain comes in to your office. Dr. John who is a part of the group, a Physiatrist saw the patient. The history shows that the same patient was seen by Dr. Smith 30 months ago for the same problem and both physicians are under the same group and with the same specialty. This patient is considered as “Established Patient” following the 3 year rule for Evaluation and Management. Step# 2 Determine if the Patient is New or Established when billing for evaluation and management So when billing for evaluation and management, just remember that a “new patient” is defined as an individual who has not received any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous three years. An established patient is an individual who has received professional services from the physician/NPP or another physician of the same specialty who belongs to the same group practice within the previous three years. So by reading the above, it is very easy to determine what type of patient are you going to be billing for – New or Established patient. You also must be aware that it is possible you have different sub-specialty in your practice. For Example: A Family Practice physician is the primary care doctor for an established patient comes in to the office with a sports injury. The patient was then seen by a Family Practice physician whose “Sub-specialty” is Sports Medicine . This patient becomes a “New Patient” due to the fact that the patient was seen by one of its physicians who has a different sub-specialty from the other physician (under the same group). Choosing the right patient type (either New or Established) require a “Face-to-Face Encounter”. Some physicians may experience providing a non face-to-face encounter like going over the diagnostic reports over the phone – this does not automatically establish a “New Patient” type since there is no face-to-face encounter had occured. On the Medicare Claims Processing Manual – section 30.6.7, it says there – “An interpretation of a diagnostic test, reading an X-ray or EKG, etc., in the absence of...

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