Medicare Compliance & Reimbursement

Question: We saw a patient over a year ago for a thyroidectomy, and now the patient returned to our practice with sinus complaints. The physician performs a nasal endoscopy. Should we bill the nasal endoscopy encounter as a new patient since she's coming back for a different reason and seeing a different otolaryngologist? Answer: No, you should not bill this case as a new patient. You should bill this as an established patient for several reasons. If your otolaryngologist sees a patient any time within a 36-month period, that patient is considered established, regardless of the reasons for the visits. This is the AMA's "three-year rule." You should go by this rule even if another physician in your practice sees the patient, as long as it's within the 36 months. Caveat: This rule applies as long as all the physicians in your group bill under the same group number. Change [...]