Outpatient Facility Coding Alert - 2006 Issue 14
Billing: CMS Transmittal Clarifies Proper E/M Claims Filing
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Article Overview
This article covers a CMS clarification affecting office evaluation and management billing, with emphasis on how practices determine whether a patient is considered new for coding purposes. It is aimed at coders, billers, compliance staff, and physician practices that submit Medicare-related E/M claims. The discussion focuses on CMS guidance, same-practice considerations, specialty-related distinctions, and the impact on claim filing and correction processes.
Why This Topic Matters
Correctly identifying new-patient status affects E/M claim selection and helps practices avoid filing errors and resubmissions.
What You Will Learn
- How CMS clarified the definition of a new patient for office E/M billing
- Why face-to-face services matter in determining patient status
- How same-practice and same-specialty considerations affect claim filing
- What general situations may require claim correction or resubmission
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practice administrators
- Medicare claims processors
Codes Discussed
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