Medicare Compliance & Reimbursement

A consult shared is a problem doubled.

False: You can have a nurse practitioner (NP) or physician assistant (PA) come in and start off a consult. The NP or PA can do the work up and ask the patient some questions, and then the doctor can come in afterwards and review their work. You can bill this as a consultation.

True: Medicare doesn't allow you to bill consults as "shared visits," says consultant Maggie Mac with Pershing Yoakley & Associates in Clearwater, FL. When a doctor asks for a consult, he or she is seeking only your physician's opinion, not the opinion of other providers in your office.

The Centers for Medicare & Medicaid Services clarified that you can't bill a shared consult last year. But many providers still don't realize that Medicare doesn't allow this practice, says Mac.

Also, many providers believe you can bill a shared visit in the physician office setting, instead of the hospital. But because shared visits in the physician office must follow the "incident-to" billing rules, there's no point in billing an office shared visit, says Mac.