Compliance: Fortify 3-Year Rule Smarts with Expert Tips

Why This Topic Matters

Correctly identifying patient status affects coding accuracy, compliance risk, and reimbursement. The article is useful for practices that want a clearer understanding of the general framework behind patient-status decisions and the operational impact of getting them wrong.

Article Sections

1. Focus on this Basic CPT® Guidance

   Introduces the CPT framework for determining patient status and summarizes the broad factors involved in that assessment. It emphasizes the general criteria used in practice settings and the role of face-to-face professional services.

2. Don’t Forget About Exceptions

   Covers common situations that may not affect patient status in the usual way and discusses why exceptions matter in routine practice. The section uses a vaccination scenario to illustrate the broader topic.

3. Skip 99211 for New Patients

   Addresses a common office-visit misconception involving an established-patient service and explains why it is discussed in the context of new versus established patient status. The section focuses on the general coding and workflow implications rather than detailed coding instructions.

4. Why Does this Matter?

   Explains the compliance and reimbursement significance of correctly classifying patient status. It also notes the documentation and evaluation-and-management differences that make the issue important for billing operations.