2025 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2024-Overview of Split-Shared-Incident-to Guidelines & Documentation-

Video Transcription

Video Summary

The video discusses split-shared and incident-to billing practices in healthcare, focusing on the specific requirements needed for each process. Split-shared services involve both a physician and an advanced practice provider (APP) or non-physician practitioner (NPP) performing parts of an encounter, and should be billed under whoever performs the substantive portion of the visit. This portion can be based on time or decision-making. Incident-to billing is when services are provided as part of a physician's established plan but performed by an APP under direct supervision in an office setting. Each payer, including Medicare and commercial insurers, has its own policy, which practices must adhere to for correct billing. Documentation and understanding the differences between shared and incident-to services, and payer-specific policies, are crucial for compliance. The session emphasizes the need for communication with insurance provider reps, adherence to state supervision rules, and accuracy in billing practices concerning APPs.

Asset Subtitle

Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM

Meta Tag

Concept Split/Shared Visit

Concept Incident-to service

Concept Medicare Billing Rules

Concept Substantive Portion

Concept Direct Supervision

Keywords

split-shared billing

incident-to billing

advanced practice provider

payer-specific policies

healthcare compliance

billing documentation

Split/Shared Visit

Incident-to service

Medicare Billing Rules

Substantive Portion

Direct Supervision