Medicare Compliance & Reimbursement

Question: Can qualified advanced practice providers (APPs) “split” a service with a physician for Medicare patients. I heard some other coders discussing the practice the other day. How can APPs and physicians “split” visits? And how would you bill for split visits?

Minnesota Subscriber

Answer: A split/shared visit involves two providers and a patient. During a split/shared visit, the physician and a qualified APP each perform a substantive portion of an E/M service for the same patient on the same date of service in certain sites of service (hospital inpatient/hospital outpatient or emergency department). Shared services in an office location must meet “incident-to” requirements to be reported under the physician. You can only report split visits on E/M codes; the split visit exception doesn’t apply to procedure codes.

Benefit: When you bill an E/M service as split/shared, you can bill under the physician’s National Provider Identifier (NPI), which will garner the practice 100 percent reimbursement for the service. When you bill for services under a qualified APP’s NPI, you’ll only be able to collect 85 percent of the total reimbursement for the service.

Caveat: To bill a shared visit under the physician’s NPI, the provider must provide and document a face-to-face service for the patient. General oversight, such as reviewing the medical record, is insufficient to report under the physician’s NPI. Also, split/shared billing began as a Medicare concept. Although many other payers follow these rules, they are not universal and practices should follow the specific rules of each individual payer.