Alex Kirkland and Chris Marrs join Mark Reiboldt to discuss changes to the split or shared billing between advanced practice providers and physicians. Alex and Chris encourage healthcare organizations to understand these changes and update processes before the changes take effect in 2024.

Podcast Information 

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Episode Synopsis 

A split/shared visit, defined as “an E/M visit in a facility setting that is performed in part by a Physician and an NPP who are in the same group,” is billed based on which provider performed the “substantive portion” of the service.

For non-critical care split/shared visits in 2022, a “substantive portion” is considered “all or some portion of the history, exam or medical decision-making key components of an E/M service.” However, for critical care visits in 2022 and all applicable visits beginning January 1, 2023, a “substantive portion” is more specifically defined as greater than 50% of the time spent on the encounter.

If the physician spends more than 50% of the time with the patient, CMS will reimburse the visit at 100%. However, if the advanced practice provider spends more than 50% of the time with the patient, they will reimburse the visit at 85%. The provider attached to the service will also receive the wRVU credit for those professional services.

Listen to the episode and learn how these changes could impact how your providers are reimbursed and compensated for their professional services.

Extras

• Major Changes to Split/Shared Billing Affect Advanced Practice Providers and Physicians
• American Medical Association Releases 2023 E/M Updates
• How the CY 2022 PFS Final Rule Affects Split/Shared Visits and Critical Care Services