decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 11 (November)
Medicare’s split/shared service rules don’t apply to residents
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Article Overview
This article clarifies a Medicare coding and billing distinction that affects teaching settings, resident involvement, and physician-to-physician shared evaluation and management services. It is relevant to coders, billers, compliance staff, and physicians who work in teaching hospitals or group practices and need to understand the broad framework of Medicare’s split/shared policies versus teaching physician rules. The article also discusses general Medicare handling of same-specialty care across office and hospital settings, including per-day reporting concepts and higher-level service reporting.
Why This Topic Matters
Mistaking teaching physician rules for split/shared E/M policies can lead to incorrect billing workflows and compliance risk. The article helps readers understand which Medicare policy framework applies in common academic and group-practice scenarios.
Article Sections
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Resident participation under teaching physician rules
This section addresses how resident involvement is treated in teaching settings and distinguishes that framework from Medicare split/shared E/M policy. It focuses on the overall relationship between resident work and teaching physician billing.
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Physicians sharing E/M services
This section covers general Medicare guidance for physicians who share evaluation and management services outside the teaching-physician context. It describes broad considerations for same-specialty care in office and hospital settings.
What You Will Learn
- How Medicare distinguishes split/shared E/M policy from teaching physician rules
- How resident participation is framed in teaching settings
- How shared evaluation and management services are generally treated between physicians
- What broad billing concepts apply to same-specialty care across office and hospital settings
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physicians
- Teaching hospital staff
- Practice managers
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