decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 2 (February)
Shared services not OK for consultations
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Article Overview
This article reviews Medicare guidance on split/shared evaluation and management billing and highlights where office consultations differ from other visit types. It is aimed at coders, billers, and practice staff who need to understand Medicare policy, carrier reminders, and the roles of physicians and non-physician practitioners in shared visits. The discussion covers general policy, common problem areas, and a side-by-side look at when shared services are permitted or prohibited across office and hospital settings.
Why This Topic Matters
Understanding these Medicare rules helps practices avoid billing errors and claim denials when physician and non-physician practitioners both participate in a visit. It is especially relevant for groups that use shared workflows for evaluation and management services.
Article Sections
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Medicare policy on split/shared consultation services
Introduces Medicare’s position on shared billing for consultations and summarizes the policy context behind the article. It also references carrier reminders and the types of visit components often involved in shared workflows.
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Medicare on E/M visits
Provides a general overview of split/shared evaluation and management policy and organizes the discussion by care setting. The section compares office and hospital visit categories and notes where shared service billing is addressed.
What You Will Learn
- How Medicare treats split/shared evaluation and management visits in different settings
- Why office consultations are treated differently from other shared visits
- Which general visit components are commonly delegated in shared workflows
- How carrier education materials reinforce Medicare consultation policy
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physician groups
- Non-physician practitioners
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