SHARED VISITS: Shared Visits Can Net 15 Percent More on Some E/M Services

Why This Topic Matters

Shared visit rules affect how hospital E/M services are reported and which provider NPI can be used on the claim. Understanding the documentation and participation requirements helps practices apply Medicare billing guidance consistently and avoid incorrect claim submission.

Article Sections

1. Incident-to billing versus shared visits

   Introduces the difference between office-based incident-to billing and hospital shared/split visit billing. Explains the setting where each concept applies and why the distinction matters for reimbursement.

2. How a typical shared visit is documented

   Describes the general sequence of work by the nonphysician practitioner and physician in a shared encounter. Covers the need to combine documentation from both providers to support billing level determination.

3. Medicare guidance on physician face-to-face involvement

   Summarizes Medicare manual guidance on when a shared hospital E/M service may be billed under either provider NPI. Notes the role of physician face-to-face participation in the encounter.

4. When billing under the nonphysician practitioner is appropriate

   Addresses situations where physician documentation does not show the required patient contact. Discusses why the service may then be reported under the nonphysician practitioner’s NPI.

5. Limits on services eligible for shared billing

   Identifies categories of hospital E/M services that are not included in shared billing. Clarifies that the guidance does not apply universally to all hospital encounters.

6. Supervision and documentation requirements

   Reviews availability expectations for the physician and the general supervision context. Also outlines recordkeeping and signature elements needed to support the claim.