Look at tax ID, specialty to determine a patient’s new or established status

Why This Topic Matters

Correctly identifying new versus established patient status affects E/M reporting and compliance risk. The article is relevant for practices with multiple locations, shared tax identification numbers, and physicians whose specialties or subspecialties differ.

Article Sections

1. Questions about multiple practice locations and patient status

   Introduces common billing questions involving patients moving between offices, physicians, and practice entities. Focuses on how organizational structure and provider relationships affect outpatient visit classification.

2. Answer and explanation of established patient status

   Summarizes the general approach to determining established status in a shared practice setting. Discusses the role of group enrollment details, specialty alignment, and the time period considered.

3. Compliance concerns and enforcement activity

   Notes increasing scrutiny of office visit billing errors and references recent settlement activity. Provides context for why accurate patient-status reporting matters to compliance efforts.

4. Specialty and subspecialty considerations for a new physician

   Addresses a scenario involving a physician joining a group with a related but distinct specialty designation. Covers how enrollment and specialty classification can affect outpatient E/M reporting.

5. Resources

   Lists CMS manuals and supporting reference materials related to patient status and provider taxonomy. Serves as a pointer to background documentation rather than substantive guidance.