2022 Gastroenterology Reimbursement and Coding Update: Concrete Solutions to Strengthen Your Foundation in GI Coding and Billing (On-Demand) | 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 highlights the guidelines and rules set by CMS and various commercial payers for billing these services.<br /><br />Incident-to services are defined by CMS as services that are part of a patient's normal course of treatment, where a physician has performed an initial service and remains actively involved in the patient's care. The presenter emphasizes that incident-to services must be documented appropriately and can only be billed if the physician is present in the office suite to provide assistance if needed.<br /><br />Split-shared services refer to E/M visits provided by a physician and an advanced practitioner in the same group. The presenter explains that starting from 2023, the substantive portion of the visit will be determined by more than half of the total time spent. Documentation must clearly identify the contributions of both providers, and a modifier may be required to indicate that the services were provided in collaboration with a physician.<br /><br />The document also mentions specific billing policies of various commercial payers such as Anthem BCBS, UnitedHealthcare, Aetna, and Cigna. It advises practitioners to familiarize themselves with the specific policies of these payers regarding advanced practitioner billing.<br /><br />Overall, the document provides a comprehensive overview of incident-to and split-shared services, including guidelines from CMS and commercial payers. It serves as a useful resource for practitioners to ensure accurate and compliant billing practices for advanced practitioner services.

Keywords

advanced practitioner billing

incident-to services

split-shared services

CMS guidelines

commercial payers

billing rules

physician involvement

documentation requirements

E/M visits

billing policies