Medicare Compliance & Reimbursement - 2019 Issue 4
Compliance: Boost 3-Year Rule Knowledge with This Primer
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Article Overview
This premium article provides a compliance-focused overview of CPT guidance on new versus established patient status. It discusses the general framework used in E/M coding, the types of services and encounters that affect patient classification, common misconceptions, and why accurate status assignment matters for reimbursement and compliance. The article is aimed at coders, billers, compliance staff, and practices that need a clearer understanding of the three-year rule and related guidance.
Why This Topic Matters
Correctly identifying new versus established patient status affects E/M code selection, reimbursement, and compliance risk. The article is relevant to organizations that want to reduce claim errors and better understand how CPT guidance applies in practice.
What You Will Learn
- How CPT guidance distinguishes new and established patient status
- Which general factors affect patient classification
- Why certain common encounters may not change patient status
- Why accurate patient status assignment matters for compliance and payment
- How documentation expectations differ at a high level between new and established visits
Who Should Read This
- Medical coders
- Medical billers
- Compliance professionals
- Physician practices
- Revenue cycle staff
- Healthcare administrators
Codes Discussed
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