2023 And Beyond: The Evolution Of Split Shared Billing In Medicare

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2023 And Beyond The Evolution Of Split Shared
Billing In Medicare


















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2023 And Beyond The Evolution Of Split Shared
Billing In Medicare

• Physician assistants (PAs) and nurse
  practitioners (NPs), collectively known as
  advanced practice providers (APPs), play a vital
  role in healthcare across various specialties.
  Their responsibilities, including billing for
  clinical and procedural services, have evolved
  significantly. In particular, the Centers for
  Medicare and Medicaid Services (CMS) has
  implemented substantial changes to split/shared
  billing policies, impacting APPs and physicians
  treating patients collaboratively. To understand
  these changes, tracing the historical timeline
  that led to the evolution of split/shared billing
  services in the United States is essential.
• Before 1997, CMS recognized NPs and PAs as
  facility support staff, reimbursed through the
  hospitals cost report without Part B billing.
  The Balanced Budget Act of 1997 marked a pivotal
  shift, allowing APPs to be recognized as Part B
  providers. While advancing clinical practice,
  this change posed financial challenges as APP
  salaries could no longer be included in the
  hospitals cost report. To address this, CMS
  introduced the practice of split/shared billing,
  enabling joint billing for Evaluation and
  Management (E/M) services by physicians and APPs.

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The Split/Shared Practice

• The split/shared practice allows E/M services
  jointly performed by a physician and APP to be
  billed at 100 of the Medicare Physician Fee
  Schedule (MPFS) under the physicians name and
  National Provider Identifier (NPI) number.
  Historically, these services were often billed
  under the physicians name, with minimal
  requirements on physician participation or
  documentation levels. However, as part of its
  annual rulemaking process, CMS updated the
  split/shared guidelines in 2022, introducing
  significant modifications.
• Attribution of Billing
• Critical Care and Skilled Nursing Facility
  Services
• Documentation and Billing Modifier
• Transition Period
• Transition to Time-Based Attribution
• Unclear Documentation Requirements

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Final Thoughts The evolution of split/shared
billing

• The evolution of split/shared billing in Medicare
  reflects a dynamic interplay between regulatory
  changes, financial considerations, and the need
  for clarity in documentation and attribution. As
  CMS moves towards a time-based model, healthcare
  providers face challenges adapting their billing
  practices and ensuring compliance.
• Outsourcing to 24/7 Medical Billing Services
  emerges as a strategic solution, offering
  expertise to navigate the complexities of
  regulatory changes. Such a professional medical
  billing company specializes in staying abreast of
  the latest guidelines, ensuring accurate billing,
  and mitigating the risk of non-compliance. By
  entrusting billing processes to these
  professionals, healthcare providers can
  streamline operations, enhance efficiency, and
  focus on delivering high-quality patient care.
  Outsourcing becomes a valuable ally in
  maintaining financial stability, fostering
  adaptability to evolving regulations, and
  ultimately contributing to sustained growth in
  the healthcare industry.

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About us

• We are a medical billing company that offers
  24/7 Medical Billing Services and support
  physicians, hospitals, medical institutions and
  group practices with our end to end medical
  billing solutions. We help you earn more revenue
  with our quick and affordable services. Our
  customized Revenue Cycle Management (RCM)
  solutions allow physicians to attract additional
  revenue and reduce administrative burden or
  losses.
• Media Contact
• 24/7 Medical Billing Services
• 28405 Osborn Road, Cleveland, OH 44140
• Phone no / Fax [phone]
• Email us info_at_247medicalbillingservices.
  com

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