decisionhealth Newsletters, Part B News - 2009 Issue 4 (April)
Ask a Part B News expert
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Article Overview
This short expert Q&A explains a Medicare billing topic involving patient status determination when care occurs in different residential settings. It is aimed at physician practices, billing staff, and coders who need to understand the general guidance discussed in CMS manual references and related Part B billing rules.
Why This Topic Matters
Correctly identifying patient status affects evaluation and management reporting and helps avoid billing based on the wrong assumption that a new location automatically changes how a patient is classified.
What You Will Learn
- How Medicare distinguishes new and established patients at a high level
- Why place of service alone is not the basis for patient status
- What CMS manual guidance is cited as the source of the discussion
- How this issue may arise in nursing home and assisted living settings
Who Should Read This
- Physician practices
- Medical coders
- Billing staff
- Practice managers
- Compliance staff
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