Evaluation and Management Services

Now, let's talk a little bit about basic definitions, terminology, and acronyms. Now we have provided you with a downloadable document as well as these are included in the example insurance manual, so that you can keep by your side for ease of reference on a daily basis. Now, I'm not going to go over all of them because there are just a few but I do want to provide you with some that I feel are key essentials that'll make your job just a little bit easier as you're getting started.

The first is evaluation and management services or acronym EM. It's important to note that each state has specific guidelines that your doctor must follow for diagnosing and documenting and Reporting. They’ll provide you with the appropriate EM level and diagnosis for billing, so that you can successfully file a claim and we’ll go over those a little bit more here in a few minutes, but I want to start by making sure that you understand the difference between a new versus an established patient. This is important and can easily be overlooked and end up costing both the patient as well as the practice money by overcharging the patient or on the practice not getting paid the appropriate amount. For example, we have a patient come in and we bill them as an established patient when they were truly a new patient and this ends up being a loss of revenue for the practice.

So, here are the rules: a new patient is somebody who has not been in your practice in the last 3 years or they’ve never been in. It’s important to note that they may have been seen in your practice before but if it has not been in the last 3 years to the calendar day of their last exam Medicare states that we bill them as a new patient. And then, an established patient, pretty simple, they’ve been in within the last three years.