The display copy of the Quality Payment Program proposed rule was released in June, and you can think of this rule as a companion to the Medicare Physician Fee Schedule that typically comes out with the OPPS rule. That means both rules need to be read, understood, and, ideally, commented on by providers.
As CMS and third-party payers have looked for ways to treat patients in the outpatient setting and reduce inpatient volumes, CMS has used the 2-midnight rule, in addition to other methods, to treat patients as outpatients or in observation whenever possible.
Whether it is the CPT Manual or Chapter 12 of the Medicare Claims Processing Manual, the definition of a “new patient” is the same for physicians and nonphysician practitioners billing. But that doesn't mean coding and billing for E/M services is clear cut.
Mary, a medical case manager, was comforting Susan, the daughter of one of her patients, who was distressed because her mother was hospitalized with a broken hip. Susan, an only child, was the primary caregiver for both her parents. After visiting her mother in the hospital, Susan would run home to provide evening care for her father, who had a home-care technician during the day.
