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tci Part B Insider - 2008 Issue 6

PART B MYTHBUSTER: Keep Physician Specialty in Mind When Determining New vs. Established Patient Status

But 3-year rule applies in most other situationsMyth: Medicare's -three-year rule,- which designates patients as new or established, overrides all other Medicare guidance, so you must use it in every situation.Reality: If the patient has been to the practice within the last three years, he may still qualify as a -new- patient under Medicare guidelines, depending on which specialist he sees in the practice.As most practices know, if the physician, or any physician of the same specialty billing under a common group number, has never seen a patient before, you should automatically categorize that patient as...

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