decisionhealth Newsletters, decisionhealth - 2009 Issue 2 (February)
Shared Visits / Questions still remain about shared visits and consultations
Subscribe or sign in to view the full article.
Article Overview
This article explains how Medicare policy addressed shared or split evaluation and management services when physicians and non-physician practitioners both participate in care. It reviews the general reimbursement framework, how settings such as the office, hospital, emergency department, and consultations are treated, and why some questions remained unresolved in later guidance. The article is useful for coders, billers, reimbursement staff, and clinicians who need a high-level understanding of shared-service billing under Medicare.
Why This Topic Matters
Shared visits can affect how services are reported, which provider is linked to the claim, and the level of payment associated with the encounter. Understanding the policy distinctions helps reduce billing errors and identify situations that still require careful payer review.
Article Sections
-
Shared services and Medicare policy background
Introduces shared or split evaluation and management services and explains why Medicare policy changes created significant billing questions. Summarizes the general reimbursement context for physician and non-physician practitioner participation.
-
Office or clinic setting
Covers the office-based framework for shared encounters and the relationship between shared visit concepts and incident-to billing in this setting.
-
Hospital inpatient, outpatient, and emergency department setting
Discusses shared-service billing in hospital-based settings and the conditions that affect how the encounter is reported and paid.
-
Consultations
Notes the article's discussion of consultation services and the remaining uncertainty in Medicare policy at the time.
-
Final reminder about physician participation
Emphasizes that physician involvement must go beyond discussion with the non-physician practitioner and include a personal face-to-face professional service.
What You Will Learn
- How Medicare framed shared or split evaluation and management services
- How billing considerations vary by care setting
- What issues remained unclear in consultation-related guidance
- Why physician participation requirements still matter in shared encounters
Who Should Read This
- Medical coders
- Medical billers
- Reimbursement specialists
- Physician practices
- Hospital billing staff
- Non-physician practitioners
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com