Shared service rule does not apply to consultations

Why This Topic Matters

Understanding this policy helps practices determine when shared service billing concepts apply and when they do not, especially in settings where physician and nonphysician provider collaboration is common. It is relevant for compliance, reimbursement accuracy, and documentation practices under Medicare guidance.

Article Sections

1. Medicare clarification on shared service billing

   Introduces the Medicare policy clarification and the broader question of how shared services relate to consultation billing. It references CMS guidance and the administrative context for the change.

2. Prior guidance and industry interpretation

   Summarizes earlier Medicare transmittal language and the way it contributed to confusion about shared billing for evaluation and management services. It includes comments from industry representatives about the policy history.

3. Office consultations and incident-to versus shared visit concepts

   Discusses how these billing concepts are viewed in office-based settings and contrasts the general frameworks used for follow-up care. It focuses on the setting rather than specific code selection.

4. Hospital shared services and required criteria

   Explains the hospital setting where shared services remain relevant and outlines the broad conditions discussed by the article. It addresses documentation and participation considerations for physician and nonphysician provider services.

5. Documentation expectations for the physician portion

   Describes the general point that the physician must provide and document a face-to-face component of the service. It also notes the article’s discussion of flexibility in the amount of physician involvement.