decisionhealth Newsletters, Answer Books - 2010 Issue 8 (August)
Answer_Book / Consults,_Visits,_Referrals / CONSULTS_VISITS_REFERRALS
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Article Overview
This short article covers the basic distinction between consultation services and referred visits in a physician or non-physician practitioner setting. It is aimed at coders, billers, and clinicians who need a high-level understanding of consults, referrals, and related Medicare claim documentation concepts. The discussion also references a CMS claim-processing source and related billing guidance chapters.
Why This Topic Matters
Understanding whether a patient encounter is treated as a consult or a visit affects how the service is reported and documented. The article also highlights related Medicare and claim-form considerations that can influence billing workflows.
What You Will Learn
- How consult services differ from referred visits at a general level
- How non-physician practitioners may fit into consult-related services
- Why scope of practice and specialty differences matter in consult scenarios
- What claim-filing information is mentioned in connection with requested services
Who Should Read This
- Medical coders
- Medical billers
- Physicians
- Non-physician practitioners
- Practice managers
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