Outpatient Facility Coding Alert - 2022 Issue 16
Reader Questions: Conquer Shared Service Billing Rules With This Advice
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Article Overview
This article addresses a Medicare billing question about shared or split evaluation and management services involving a physician and a nurse practitioner. It explains the distinction between institutional and office settings, references CMS policy changes effective in 2022, and points readers to Medicare guidance on incident-to services in the Medicare Benefit Policy Manual. It is relevant for coders, billers, and compliance staff who work with Medicare office visits and shared service documentation.
Why This Topic Matters
Understanding whether a service can be billed under Medicare depends on the setting and the applicable policy framework. This article helps readers recognize when CMS split-visit rules apply and when broader Medicare incident-to guidance becomes relevant.
Article Sections
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Question
A reader asks about billing a follow-up visit involving both a physician and a nurse practitioner, including how the service was documented and who performed the work.
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Answer
The response discusses Medicare policy changes, the settings affected by split or shared visit rules, and where incident-to guidance fits into office-based services. It also cites a CMS manual reference for additional background.
What You Will Learn
- How Medicare policy distinguishes shared or split visits by setting
- How incident-to guidance relates to office-based evaluation and management services
- Where to find CMS manual guidance for additional context on Medicare coverage rules
- What types of documentation and participation are discussed in shared-service billing questions
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Compliance professionals
- Physician practice managers
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