Wiki Shared/Split Visits and Commercial Payers?

[tori.a]

Which commercial carriers accept shared/split inpatient visits? I've been trying to make a list. I see UHC does. They have it listed as a split/shared visit policy and they list modifier FS on their modifier reference policy. Any other carriers accept this? I see that BCBS of Minnesota accepts modifier FS, but I don't think this applies to all states (I'm in FL).

Thanks.

 

[csperoni]

I am not aware of any carrier that does not accept split/shared, but HOW those are billed could certainly vary (use of modifiers, etc)
I personally would not trust anyone else's list and would check the information myself. Additionally, my contracts could vary from someone else's contracts, particularly when dealing with large healthcare systems who may alter their typical contracts and policies for large systems. If you do not have any special contracts, the information would typically be on their websites and/or provider manual.

 

[tori.a]

I am not aware of any carrier that does not accept split/shared, but HOW those are billed could certainly vary (use of modifiers, etc)
I personally would not trust anyone else's list and would check the information myself. Additionally, my contracts could vary from someone else's contracts, particularly when dealing with large healthcare systems who may alter their typical contracts and policies for large systems. If you do not have any special contracts, the information would typically be on their websites and/or provider manual.

Thank you for your reply! The issue is I haven't been able to find any information on some carrier websites/manuals. Some don't have a split/shared visit policy and don't list modifier FS on their modifier reference policy. I've only been able to find anything for commercial UHC. Since it's a CMS policy, I'm guessing some of them just don't accept them? I don't have access to our conttracts so I'm really just flying blind here, trying to find their policy information online.

 

[csperoni]

Payor contracts (at least in my experience) often have some type of language that says they follow Medicare guidelines for anything they don't have their own policy for. I would not assume payors won't allow you to count the work of both providers. Split/shared was always allowed by both CMS and AMA guidelines. It is referenced in the AMA 2023 guidelines. It's likely also in the CPT manual. The new (maybe 2022) Medicare guideline is only regarding which provider bills for it and requiring -FS. I would bill that way for any carrier not having a specific policy.

 

[jkyles]

Which commercial carriers accept shared/split inpatient visits? I've been trying to make a list. I see UHC does. They have it listed as a split/shared visit policy and they list modifier FS on their modifier reference policy. Any other carriers accept this? I see that BCBS of Minnesota accepts modifier FS, but I don't think this applies to all states (I'm in FL).

Thanks.

I recommend doing a search for "Modifier FS" to get an idea of who follows Medicare's split/shared guidelines.