DecisionHealth, DecisionHealth - 2012 Issue 7 (July)

Review new vs. established rules to avoid CMS scrutiny, downcodes

Your revenue is at risk with Medicare poised to automatically filter claims for errors related to new versus established patients. Too many mistakes could look like abusive billing or intentional ignorance about coding rules.

New patient visits pay more than established visits of the same level, but if you bill a new patient with a lower-paying established patient code, you’ll miss out on revenue you’re owed.

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