ED Coding & Reimbursement Alert - 2013 Issue 19
Shared Visits: Avoid Becoming a CERT Statistic and Paybacks
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Article Overview
This article covers how shared or split visits are handled in office, hospital inpatient, outpatient, and emergency department settings, with emphasis on documentation, supervision, and billing attribution. It is aimed at coders, billers, compliance staff, and practice administrators who need to understand when a service may be billed under a physician or nonphysician practitioner identifier and how to avoid payment problems. The guidance also discusses CMS policy language and practical documentation expectations for supporting these encounters.
Why This Topic Matters
Correctly distinguishing shared visits from other billing arrangements can affect payment, compliance risk, and whether a claim is subject to denial, overpayment recovery, or audit scrutiny.
Article Sections
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Billing context for shared visits
Introduces the relationship between office and hospital billing arrangements and explains why the article focuses on shared visits and related payment concerns.
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Face-to-face time is a must
Discusses the role of same-day physician participation, documentation, and CMS guidance for hospital and emergency department encounters. It also notes limits on where shared billing may be used.
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Make sure physician is available
Covers supervision expectations, provider availability, and the documentation elements needed to support shared-service billing.
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Examples
Provides illustrative CMS examples showing how shared visits may be documented and reported in different settings.
What You Will Learn
- How shared or split visit billing differs from incident-to billing
- What general documentation elements support a shared visit
- How physician participation affects billing attribution
- What settings and service types are discussed for shared visit reporting
- Which CMS guidance is referenced in relation to shared visits
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
- Revenue cycle professionals
- Physicians
- Nonphysician practitioners
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