Medicare Compliance & Reimbursement - 2012 Issue 2
Reader Question: The CMS Shared Services Documentation Exemption Only Applies to E/M Services
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Article Overview
This article addresses a billing question involving an emergency department encounter where one provider performs the evaluation and management portion and another performs a procedure. It explains the general scope of CMS shared services documentation guidance, how payer policies can differ, and why this issue matters for practices billing physician and nonphysician provider services. The discussion is aimed at coders, billers, and clinicians who need to understand documentation and claim-submission considerations across Medicare and commercial payers.
Why This Topic Matters
Billing for split work between physicians and nonphysician providers can affect claim submission, reimbursement, and compliance. Understanding which services fall under shared service guidance and how different payers may handle documentation requirements helps reduce claim errors and denials.
What You Will Learn
- How the article distinguishes evaluation and management services from procedures in a shared-service context
- How the article frames billing responsibility when more than one provider documents care
- How payer policy differences can affect claim submission for physician and nonphysician provider services
- How Medicare-oriented guidance may differ from commercial payer expectations
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Emergency department administrators
- Physicians
- Nonphysician providers
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