by David M. Glaser, Esq.
Sep 6th, 2023
Can you do a “shared visit” in a physician clinic, site of service 11? The most common answer to this question seems to be “no,” and while that is technically correct, it is so misleading that it is effectively entirely wrong.
To understand this confusion, we need to dig into the regulatory definitions of “shared visits” and billing “incident to” a physician. Before I do that, though, let me declare that when a physician and a non-physician practitioner (NPP) both see the patient in the clinic on the same day, it is totally appropriate to combine their work and bill it under the physician. Just don’t call it a shared visit.
As you know, at the beginning of 2022, new regulations were issued establishing the requirements for shared visits. The regulations, now found at 42 C.F.R. § 415.150, define a split or shared visit as “an evaluation and management (E&M) visit in the facility setting that is performed in part by both a physician and a non-physician practitioner who are in the same group.”
The regulations define a facility as “an institutional setting in which payment for services and supplies furnished incident to a physician’s services is prohibited.” These regulations were issued because the “incident to” benefit does not apply in the hospital.
Because the “incident to” regulations may be used when services are provided in the clinic, the regulations define the term “shared visits” narrowly, limiting it to services occurring in a facility like a hospital or skilled nursing facility (SNF).
This article originally published on September 6, 2023 by RACmonitor.
About David M. Glaser, Esq.
David M. Glaser is a shareholder in Fredrikson & Byron's Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David's goal is to explain the government's enforcement position, and to analyze whether this position is supported by the law or represents government overreaching. David is a member of the RACmonitor editorial board and is a popular guest on Monitor Mondays.