Historically, in determining whether a physician or an NPP may bill for a split (or shared) visit, either the physician or the NPP could bill for the service as long as the billing practitioner performed a “substantive portion” of the visit.
This is an important concept because the visit is paid at a higher rate if the physician submits the claim rather than the NPP. In the final rule, CMS established which of the physician or NPP performing a split (or shared) visit can bill Medicare for the visit.
#Clarify cm professional
This definition is intended to distinguish between the policy applicable to services furnished “incident to” the professional services of a physician in a physician office setting and the policy applicable to services furnished in a facility setting. The new regulations also define “split (or shared) visit” as E/M visits performed in part by a physician and NPP in institutional settings for which “incident to” payment is not available. In issuing the new rules, CMS indicated that prior guidance had been interpreted as limiting split (or shared) visit billing to established patients and prohibited billing for split (or shared) visits involving critical care services or in SNFs. In addition to clarifying when split (or shared) visits may be billed to Medicare, the finalized regulations modify CMS’s policy and permit physicians and NPPs to bill for split (or shared) visits for both new and established patients, critical care services and certain E/M visits in a SNF. It does not appear to apply to facility services payable under a separate payment system ( i.e., for hospitals, under the outpatient prospective payment system, or for SNFs, under the SNF prospective payment system). While the finalized regulations provide the circumstances under which a physician or NPP may bill for professional services furnished to patients in a facility setting, this regulation addresses only services furnished in the facility setting and paid under MPFS.
The final rule expands the clinical scenarios under which a healthcare professional can bill for services performed in part by another practitioner but also imposes restrictions on which performing practitioners can bill for the split (or shared) visit. In May 2021, in response to a petition submitted under the US Department of Health and Human Services’ Good Guidance Practices Regulation, CMS withdrew the MCPM sections specifically addressing split (or shared) visits and indicated that CMS would reissue the guidance as proposed regulations.įor dates of service on or after January 1, 2022, the new finalized regulations specify the requirements that must be met in order for a physician or NPP to bill a split (or shared) visit in a hospital, SNF or other facility setting.
#Clarify cm manual
Instead, CMS relied solely on guidance found in the Medicare Claims Processing Manual (MCPM) to establish requirements for coverage and payment of such services. CMS regulations have not historically addressed services furnished in part by a physician and in part by an NPP in the facility setting ( e.g., hospitals and skilled nursing facilities (SNFs)).
These services are considered to be services furnished “incident to” a physician’s professional services and must meet other Medicare requirements for “incident to” services. Under CMS regulations, when a patient visit is performed in part by a physician and in part by a NPP in a physician office setting, the physician is permitted to bill for the visit under their own NPI and receive the higher Medicare payment rate. Medicare reimburses services paid under the MPFS and furnished by NPPs at 85% of the rate paid when a physician furnishes the same service.
0 kommentar(er)
