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vkratzer

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If our PA sees a patient in consultation at the hospital as an out patient, do the split/shared guidelines apply if the physician is present during the consultation? In other words, does the physician need to document his/her face to face encounter with patient in order to bill under physican number?

Thanks for your help

Vicky
 
You may not bill shared visits for consultations only established patient or subsequent hospital. And yes for a shared visit the physician must document his face to face examination of the patient. CR1776 states if the physician does not document a face to face encounter with the patient, even if he signs off on the documentation supplied by the NPP, the visit must be billed under the NPP.
 
I would check with your local carrier since some intermediary contractors do not allow NPP to perform the H&P. Below is my carriers view.

Split/share Initial Hospital Visits

Q: Can an initial hospital visit be split/shared?

A: Hospital evaluation and management visits are reported according the level of work done per day. Therefore, only one visit would be reported per date of service by any given provider, but the level of visit billed may actually be comprised of the work done by a nonphysician practitioner and a physician from the same group practice done on separate encounters the same date of service. Typically, this is seen in the performance of a subsequent hospital visit billed and paid under the physician rate of reimbursement which is acceptable provided these encounters were:

-medically necessary (i.e. the physician's portion of the work done was from an actual medically necessary face to face encounter with the patient)
-performed separately and
-were documented separately.

In the performance of an initial hospital visit, if the patient is an established patient in the group practice, we would allow this visit if split/shared; but if the patient is new to the group practice, the expectation would be that the physician provides the entire encounter and its required components to the patient (and could not be split/shared with a nonphysician practitioner).

Below is a link that also provides some good information.

http://www.proactiveconsultants.net/confusion.html
 
Last edited:
Can anyone tell me where I can find examples of Medicare's documentation requirements for Split/Shared visits?
 
Also...

EXAMPLES OF SHARED VISITS

1. If the NPP sees a hospital inpatient in the morning and the physician follows with a later face-to-face visit with the patient on the same day, the physician or the NPP may report the service.

2. In an office setting the NPP performs a portion of an E/M encounter and the physician completes the E/M service. If the "incident to" requirements are met, the physician reports the service. If the “incident to” requirements are not met, the service must be reported using the NPP's UPIN/PIN.


https://www.cms.gov/transmittals/downloads/r178cp.pdf
 
Does this rule (consultations can not be shared) still apply to carriers that accept consults now that Medicare does not accept consults?

Thanks,
Diana, CPC
Auditor at Private
 
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