09/19/2014

New Patient Visits

As a result of overpayments for New Patient E/M services, CMS has implemented changes in the Common

Working File to prompt for validation of new patient status. This may result in overpayments being identified and requested for new patient E/M services that are determined to have been submitted as “new patient” in error.

CMS guidelines specify that “new patient” means “a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years.”

For More Information:

CMS MLN Matters article MM8165

CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 12, section 30.6.7