|
Speaker |
Toni Elhoms |
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Industry |
Medical Billing Coding Webinars |
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Speciality |
Medical Billing Coding Webinars |
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Available |
All Days |
|
Duration |
60 Minutes |
Description
Split/Shared services are one of the most misunderstood categories of billing and reporting for medical practices and providers. For evaluation and management (E/M) visits jointly furnished by a physician and NPP in the same group practice in a facility setting, CMS has historically allowed the visit to be billed under the physician’s NPI.
All of that changed in 2022 with updated rules that disallowed this practice and required the visit to be billed under the NPI of the physician or NPP who either document the history, exam, or medical-decision-making for the visit OR whoever provides more than 50% of the total service time.
In 2023, the changes are even more drastic, now requiring the visit to be billed under the NPI of the individual who provides more than 50% of the total visit time. This changes everything! The 2023 split/shared service updates will have a massive impact on providers’ clinical documentation and reimbursement rates.
In today’s webinar, we take a deeper dive into the 2023 split/shared service updates and discuss the proper application of the 2023 guidelines, and clinical documentation requirements, and dissect clinical documentation scenarios to map out how this will look for medical practices in 2023.
Learning Objectives
Areas Covered
Background
The Centers for Medicare & Medicaid Services (CMS) announced new rules for 2023 split/shared visits in the facility setting. These new rules could significantly impact Medicare reimbursement for physician practices that use non-physician practitioners (NPPs) in the facility setting.
Why Should You Attend
Most medical practices that see patients in the facility setting have NPPs perform initial rounding in the hospital followed by a physician briefly seeing the patient on the same date of service. Prior to 2022 updates, medical practices would bill these split/shared services under the physician’s NPI and collect 100% of the Medicare Physician Fee Schedule (MPFS) rate.
With the changes in 2023 impacting billing methodology, it is unlikely that the total time spent by the physician will exceed the NPP’s time. Therefore, these split/shared encounters will now have to be billed under the NPP’s NPI, and the practice’s reimbursement will be reduced by 15% off the top. Split/Shared service encounters remain a moving audit target.
Who Should Attend
(CCS, CPC, CPMA, CRC)
Toni Elhoms, CCS, CPC, CPMA, CRC, AHIMA-Approved ICD-10-CM/PCS Trainer is an internationally known speaker and recognized subject matter expert on medical coding, reimbursement, compliance, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC (ACE). She holds multiple credentials with the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Toni's expertise extends to both inpatient and outpatient coding, compliance, billing, and reimbursement. She serves as ACE’s Senior Consultant and conducts training and educational seminars across the country. With well over a decade of industry experience, Ms. Elhoms has led and supported hospital systems, universities, physician practices, payers, law firms, government agencies, and other entities on coding, billing, and compliance initiatives.
Toni is a frequent contributor to various media outlets, a highly sought-after conference speaker, and a regular guest on industry podcasts. She frequently serves as an expert and consulting witness in both civil and criminal litigation matters. Ms. Elhoms was appointed as an editorial advisory board (EAB) member for The Coding Institute (TCI) in 2020. She created and regularly hosts the Alpha Coding Podcast series (rated a top industry podcast) to share her industry Pro-Tips. She is a regular volunteer and mentors a network of Revenue Cycle Management (RCM) and Health Information Management (HIM) professionals across the United States.