There are three types of visits to the office under CPT in which a provider can determine depending on the connection of the patient with the practice. Many queries exist regarding when a patient can be recognized as a new patient to a provider, still while someone else within the practice has priorly examined the patient. The guidelines in CPT clarifies the conditions when a patient is recognized as new vs. established, except insurance providers, including Medicare, have their policies to acknowledge a new patient.
The webinar session will view at the ins and outs of choosing new vs. established visits but also review consultations as an alternative that is still accessible and payable by numerous insurance carriers. It will elaborate on the reimbursement for these three categories of codes to comprehend the financial difference. Moreover, discussing the documentation standards of the three categories to reveal some surprises that you might not be aware of them.
Topics discussed in the webinar:
- CPT decision tree for new vs. established patients
- Specialty
- Sub-specialty
- Medicare guidelines for new vs. established patients
-Specialty Category
- Documentation requirements for new patients vs. established patients
- History
- Exam
- 97 Guidelines
- 95 Guidelines
- Medical Decision Making
- Common policies related to established patients and MDM.
- Potential changes to E/M guidelines in the near future
- Consultation requirements
- New patients
- Established patients
- Consultation within the same practice
- Common denials related to new vs established patients
- Patients are seen by two providers in the same practice on the same day of different specialties
- New patient visit billed and being denied because the visit doesn’t meet the criteria for a new patient
- Sample appeals when a denial has been received in error
- CPT decision tree for new vs. established patients
- Sub-specialty
- Specialty
- Medicare guidelines for new vs. established patients
- Specialty Category
- Documentation requirements for new patients vs. established patients
- Medical Decision Making
- Common policies related to established patients and MDM.
- Exam
- 97 Guidelines
- 95 Guidelines
- History
- Potential changes to E/M guidelines in the near future
- Consultation requirements
- New patients
- Established patients
- Consultation within the same practice
- Common denials related to new vs established patients
- Sample appeals when a denial has been received in error
- New patient visit billed and being denied because the visit doesn’t meet the criteria for a new patient
- Patients are seen by two providers in the same practice on the same day of different specialties
Notable criteria discussed in the session:
- Understand the decision tree in CPT® that can be utilized to decide if a patient is a new or established patient.
- Compare Medicare and CPT® requirements for new vs. established patients and be able to apply these differences for maximum reimbursement.
- The required documentation is essential based on Evaluation and Management Guidelines for new patient visits.
- Stop missing out on additional revenue when it may be suitable to report a consultation code for new or established patients to insurance carriers excepting consultations.
- The measures that are required to appeal claims when denial has been received in error.
Who can also attend:
Coders, Billers, Physicians, Physician Assistants, Nurse Practitioners, Auditors, Medical office staff from any specialty
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