Wiki Shared Split Tracking Dilema

[Peter Davidyock]

Hi Everyone

I have come into what I think to be a can of worms and I would like some thoughts on this matter.

A trauma/General Surgery service that I know uses midlevels as physician extenders. Both the midlevel and the physician will round or see a pt on the same day. The physicians have been well trained in the shared split guidelines so documentation is not the issue. Please do not respond with documentation guidelines.

The issue they are having is the billing software, particularly the "Servicing Provider". The software allows for a servicing provider, a resource, a billing provider, a rendering provider and a supervisor. There are also two spots to capture additional providers for report purposes.
The physicians are being told that when a midlevel is involved with the visit that particular person (the midlevel) must occupy the serving provider slot. When this is done the billing provider (the physician who also participated in the claim) is not being reimbursed (Corporate Physicians).
This is a recent development. In the past the servicing provider was listed as the physician and they were reimbursed. Now every time a midlevel is involved (which is about 85 to 90% of the claims) the physician is not paid. The midlevel is not paid either because they are salaried and receive nothing in additional wrvu reimbursement.

These physicians are threatening to walk. For all intents and purposes this issue will destroy this practice.
Has any one ever encountered this situation?
Thanks in advance for your time and experience.

 

[coloradopa]

Hi Everyone

I have come into what I think to be a can of worms and I would like some thoughts on this matter.

A trauma/General Surgery service that I know uses midlevels as physician extenders. Both the midlevel and the physician will round or see a pt on the same day. The physicians have been well trained in the shared split guidelines so documentation is not the issue. Please do not respond with documentation guidelines.

The issue they are having is the billing software, particularly the "Servicing Provider". The software allows for a servicing provider, a resource, a billing provider, a rendering provider and a supervisor. There are also two spots to capture additional providers for report purposes.
The physicians are being told that when a midlevel is involved with the visit that particular person (the midlevel) must occupy the serving provider slot. When this is done the billing provider (the physician who also participated in the claim) is not being reimbursed (Corporate Physicians).
This is a recent development. In the past the servicing provider was listed as the physician and they were reimbursed. Now every time a midlevel is involved (which is about 85 to 90% of the claims) the physician is not paid. The midlevel is not paid either because they are salaried and receive nothing in additional wrvu reimbursement.

These physicians are threatening to walk. For all intents and purposes this issue will destroy this practice.
Has any one ever encountered this situation?
Thanks in advance for your time and experience.

First neither mid level or physician extender is approved or appreciated. The current terminology is usually advanced practice provider (APP).
It also seems you have too may slots.
We use rendering provider and billing provider. When the patient is Medicare the APP occupies the rendering provider and the billing provider slot. The bill is submitted under the NPI of the billing provider. For other insurances, the rendering provider is the APP and the physician of the day is the billing provider and the bill is submitted under the physicians NPI but the wRVU is credited to the APP. For shared billing since Medicare states its billed under the physician NPI the physician is the billing and rendering provider. We have an additional provider slot where the APP goes so we can track for number of patients seen.

It seems that instead of billing off the billing provider you are billing off the servicing provider. Since you are putting APP in that slot you are getting reimbursed for the APP not the physician. So the system is working as intended. As I see it you have two choices.
1. Put the physician in the servicing provider slot.
2. Change the software so the bill is submitted under the billing provider.

Either of these will fix your problem. The real problem seems to be that someone who does not know how billing works, and is requiring certain providers in certain spots. That's your real problem.​