Part B Insider - 2015 Issue 4
Reader Question: Check for Another F2F in Past 3 Years
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Article Overview
This short Q&A article discusses a denial scenario involving new-patient versus established-patient status, with emphasis on face-to-face history, group practice considerations, and the role of Medicare guidance versus payer-specific policies. It is intended for coders and billing staff who need to evaluate whether prior professional services change patient designation and whether an appeal is appropriate.
Why This Topic Matters
Correctly identifying new-patient status affects claim acceptance, coding selection, and appeal strategy. The article helps readers understand when a prior service may or may not count toward the patient-status determination under commonly referenced guidance.
What You Will Learn
- How new-patient status is evaluated when prior services were not face-to-face
- Why group practice history can matter in patient-status determinations
- How Medicare guidance relates to payer-specific rules for new versus established patients
- What kind of documentation or policy review may support an appeal review
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle personnel
- Practice managers
- Compliance staff
Codes Discussed
Modifiers Discussed
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