Wiki APP Credit for Shared Visits?

tori.a

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If billing under the physician for a shared hospital visit, how does the APP get credit for performing part of the E/M service? I know it only gets billed once, under the physician in this case and with an FS modifier, but within the practice how would the APP get credit as well?
 
Getting credit to a provider for a service is a matter of how the charges are reported in your practice's billing system. You would need to figure out a way to report this service to both providers. You'd probably need a field in your system for information that doesn't go onto the claim form where you can put the APP's name and then have a reporting mechanism that will capture this and allocate or divide the RVUs that you want to report for those providers. I'd suggest contacting your software vendor to see if they can offer a solution that works for you. If not, if may be something that you'd need to do manually, such as by periodically running a report to identify all of the FS modifiers and then performing an adjustment to your providers' total RVUs.
 
Getting credit to a provider for a service is a matter of how the charges are reported in your practice's billing system. You would need to figure out a way to report this service to both providers. You'd probably need a field in your system for information that doesn't go onto the claim form where you can put the APP's name and then have a reporting mechanism that will capture this and allocate or divide the RVUs that you want to report for those providers. I'd suggest contacting your software vendor to see if they can offer a solution that works for you. If not, if may be something that you'd need to do manually, such as by periodically running a report to identify all of the FS modifiers and then performing an adjustment to your providers' total RVUs.
Thank you very much for your detailed answer! Very helpful.
 
Getting credit to a provider for a service is a matter of how the charges are reported in your practice's billing system. You would need to figure out a way to report this service to both providers. You'd probably need a field in your system for information that doesn't go onto the claim form where you can put the APP's name and then have a reporting mechanism that will capture this and allocate or divide the RVUs that you want to report for those providers. I'd suggest contacting your software vendor to see if they can offer a solution that works for you. If not, if may be something that you'd need to do manually, such as by periodically running a report to identify all of the FS modifiers and then performing an adjustment to your providers' total RVUs.
Late follow up question, but is there a certain percentage that should be assigned to the APPs? Or is this practice specific? Some have suggested 85% to APP and 15% to the MD for shared visits paid at 100%. Thoughts?
 
Late follow up question, but is there a certain percentage that should be assigned to the APPs? Or is this practice specific? Some have suggested 85% to APP and 15% to the MD for shared visits paid at 100%. Thoughts?
This is totally up to your employer and how your billing systems can be set up. If I was going to split the credit for shared visits, it doesn't seem to make sense for 85% to APP and 15% to the MD. If the MD only did 15% of the visit, it likely would not qualify to bill under the MD at 100% reimbursement.
In my healthcare organization, the billing provider gets all the credit. There is not a way to even know who the other provider was without individually going back and reading records.
 
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