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

1
(No Transcript)
2
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.
• Read Detailed Blog _at_ https//www.247medicalbilling
  services.com/blog/split-shared-billing-in-medicare
  /

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
3
2023 And Beyond The Evolution Of Split Shared
Billing In Medicare

• Historical Background
• 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.
• 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.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
4
2023 And Beyond The Evolution Of Split Shared
Billing In Medicare

• Changes in 2022
• Attribution of Billing
• Billing should be attributed to the provider
  (physician or APP) who spent the substantive
  portion of time, defined as greater than 50, in
  the patients care on that calendar day.
• Critical Care and Skilled Nursing Facility
  Services
• Critical care services and certain skilled
  nursing facility (SNF) services can be
  split/shared, and a billing modifier FS should
  be appended to all split/shared services.
• Documentation and Billing Modifier
• The rules emphasize that billing should align
  with the provider (physician or APP) who
  performed the substantive portion of time. In
  fact, a billing modifier FS is mandated for all
  split/shared services, enabling Medicare to
  identify shared services and facilitating
  additional scrutiny and targeted payer auditing.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
5
2023 And Beyond The Evolution Of Split Shared
Billing In Medicare

• Transition Period
• The implementation of these changes began in 2022
  and continued into 2023, labeled as a
  transitional year. In fact, critical care
  services, including split/shared critical care,
  are solely time-based during this transitional
  period. Meanwhile, non-critical care services can
  be attributed either to time or the performance
  of history, examination, or medical
  decision-making (MDM).
• Transition to Time-Based Attribution
• CMS plans to move to a solely time-based
  attribution model in 2024. While the 2022 rule
  aimed to align with current clinical practice,
  its impact on the team-based care model and
  revenue expectations remains uncertain. The shift
  to time-based billing raises questions about
  documentation expectations, potential fraud
  risks, and the need for clear guidance from CMS.
• Unclear Documentation Requirements
• While physicians generally bill non-critical care
  split/shared visits under the MDM rubric at 100
  of the MPFS, but the specific documentation
  requirements are unclear.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
6
2023 And Beyond The Evolution Of Split Shared
Billing In Medicare

• Impact on Billing Practices
• Under the MDM rubric, non-critical care
  split/shared visits are generally billed by
  physicians at 100 of the MPFS, provided all
  billing requirements are met. However, confusion
  persists as the rules do not clearly outline
  these requirements. For instance, face-to-face
  visits by either the physician or the APP are
  necessary, but the rule doesnt specify that the
  billing provider must perform this part of the
  visit. The lack of clarity around documentation
  levels and the requirement for both the physician
  and APP to be employed by the same group has
  contributed to confusion within healthcare
  institutions.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
7
2023 And Beyond The Evolution Of Split Shared
Billing In Medicare

• 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.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
8
Connect with an Expert Coding Company!

• Though there are many medical billing and coding
  service providers in the market, one need to find
  an expert in urology billing to boost the
  practices revenue cycle. 24/7 Medical Billing
  Services is one such knowledgeable partner in the
  field of urology billing and coding. They have a
  dedicated urology coding staff with the latest
  billing software for urology practice. Any
  urology practice can boost its revenue and
  improve patient care by collaborating with 24/7
  Medical Billing Services.
• 24/7 Medical Billing Services is the nations
  leading medical billing service provider catering
  services to more than 43 specialties across the
  entire 50 states. You can rely on us for
  end-to-end revenue cycle management. We guarantee
  up to 10-20 increase in the revenue with cost
  reduction of your practice for up to 50.
• Call us today at 888-502-0537 to know more on how
  we can help boost profitability for your
  practice.

 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
 https//www.247medicalbillingservices.com
 info_at_247medicalbillingservices.c
om
9
Call us Today
Media Contact 24/7 Medical Billing
Services, 28405 Osborn Road, Cleveland, OH,
44140 Tel [phone] Email
info_at_247medicalbillingservices.com Website
https//www.247medicalbillingservices.com/