decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 1 (January)
Medicare’s split/shared service rules don’t apply to residents
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Article Overview
This article is for coders, billers, and compliance staff who work with evaluation and management reporting in teaching settings and physician group practice scenarios. It explains the distinction between Medicare split/shared service policy and resident-related teaching physician rules, then discusses broader Medicare guidance for shared office and hospital visits among physicians of the same specialty. The article also notes documentation considerations for supporting higher-level E/M reporting.
Why This Topic Matters
Understanding the difference between split/shared policy and teaching physician rules helps avoid misapplied billing logic in resident-involved encounters. It also helps ensure shared physician E/M services are reported consistently with Medicare guidance and supported by documentation.
Article Sections
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Resident encounters under teaching physician rules
Explains how resident participation is treated in teaching physician settings and distinguishes that framework from Medicare split/shared policy. It also addresses the general relationship between residents, teaching physicians, and separately billable services.
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Physicians sharing E/M services
Summarizes general Medicare guidance for situations where physicians in the same group share evaluation and management work for the same patient. It discusses office and hospital visit reporting in broad terms and notes documentation considerations.
What You Will Learn
- How Medicare split/shared policy differs from teaching physician rules
- How resident participation fits into teaching physician E/M services
- How Medicare addresses shared E/M work among physicians in the same group
- What documentation is emphasized when reporting higher-level shared E/M services
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practices
- Teaching hospitals
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