2022 Gastroenterology Reimbursement and Coding Update: Concrete Solutions to Strengthen Your Foundation in GI Coding and Billing | November 2021-09 - Update on Advance Practitioner Billing

09 - Update on Advance Practitioner Billing_Vaughn

Pdf Summary

This document provides an update on advanced practitioner billing, specifically focusing on incident-to services and split-shared services. The presenter discusses the CMS rules for incident-to services, which require the services to be part of the patient's normal course of treatment and for the physician to provide direct supervision. Incident-to services must also be performed in a physician's office or clinic.<br /><br />Split-shared services refer to E/M visits provided in the facility setting by a physician and a non-physician practitioner (NPP) in the same group. The billing provider for split-shared services is determined by the performance of the substantive portion of the visit, which can be based on time or the performance of key components.<br /><br />The document also includes information on the financial and employment requirements that must be met for advanced practitioner providers to bill incident-to services. It is important that the NPP is an employee of the same company or group practice as the supervising physician.<br /><br />The presenter provides examples of scenarios that illustrate incident-to and split-shared services. They also mention the documentation requirements for both types of services and the need for appropriate modifiers on claims.<br /><br />The document also includes information on specific billing policies from different commercial payers, such as UnitedHealthcare, Anthem BCBS, Aetna, and Cigna. It is recommended to keep track of each payer's policy on NPP billing.<br /><br />Overall, this document provides an overview of incident-to and split-shared services and offers tips for appropriate NPP billing.

Keywords

advanced practitioner billing

incident-to services

split-shared services

CMS rules

direct supervision

physician's office

E/M visits

non-physician practitioner

financial requirements

NPP billing