Which criterion defines a new patient in relation to professional services received?

Prepare for the AAPC Certified Professional Compliance Officer (CPCO) Certification Exam. Use quizzes and detailed explanations to enhance your knowledge and boost your confidence. Excel in your exam with structured learning!

The correct choice concerning the definition of a new patient in relation to professional services received relates to the criterion that states no services from the same specialty physician have been received in the past three years. This standard is used by many healthcare organizations and insurance companies to determine the patient's status.

When a patient has not seen a particular specialty provider in a specified timeframe, often three years, they are considered a new patient for billing and coding purposes. This classification allows healthcare providers to establish a new doctor-patient relationship and often justifies comprehensive evaluations, which may include thorough health histories and more extensive initial consultations.

The other options do not sufficiently meet the criteria established for defining a new patient. Receiving services within the last year or only from out-of-network providers does not automatically disqualify a patient from being considered new, as these situations can encompass ongoing patient-provider relationships. Additionally, the option indicating no services from any provider is vague and does not address the specific context of specialty care, which is crucial for making this determination.

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