Medicare Compliance & Reimbursement

Plus: Claims reprocessing has completed, so make sure your claims have been corrected.

As many veteran coders are aware, just because CPT® makes a change, you aren't guaranteed to see Medicare follow suit. That's the case with the latest "new vs. established" patient definition that CPT® 2012 published, which won't have much impact on Part B claims, CMS reps said during a Jan. 24 Open Door Forum. Background: CPT® 2012 states, "A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years." The portions of the description that are new for 2012 are underlined. What wasn't clear to many practices was that many payers -- including Medicare -- don't acknowledge subspecialty designations in their computer systems, making the new definition irrelevant. "CMS claims processing systems do not [...]