When is a Patient Considered a “Ne...

by Steve Adams, CPC, CPC-H, CPC-I The phrase “new patient” means a patient has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years. For example, if a professional component of a previous...

How to Code that Consult in the ER

by Steve Adams, CPC, CPC-H, CPC-I   When seeing a patient in the ER you have a few options to consider before billing your face-to-face service. This will be based on the reason for the visit, the results of the visit, and on the patient’s insurance. Example 1: If you meet your established patient in the ER as a courtesy to the patient and not because it is a true emergency, you...

Guidelines for Physician review of Healt...

By Kevin S. Little, J.D. Some health plans would have you believe that all terms and conditions in health plan contracts are immutable.  That is not true.  Health plan contract language can and should be negotiated under some circumstances.  All physicians are strongly cautioned against blindly signing health plan contracts or any “paper work” that comes across your desk...