Avoid Reduced Reimbursement: Respond properly to the Final Rule For Split/ Shared Services
November 4, 2022Authors
Ever since CMS released the 2022 Medicare Physician Fee Schedule Final Rule for Split/Shared Services (the “Final Rule For Split/Shared Services”) Garfunkel Health Advisors (“GHA”) has busily been assisting clients in responding properly to these new requirements and by conducting provider outreach and education. These comprehensive efforts by GHA are designed to ensure that clients avoid running afoul of these new mandates and thereby suffer the consequences, including reduced reimbursement.
CRITICAL COMPONENTS OF THE FINAL RULE FOR SPLIT/ SHARED SERVICES
Under the Final Rule For Split/Shared Services, split/ shared services refers to “Evaluation and Management” (“E/M”) services provided in a facility setting by both a physician and a non-physician provider (“NPP”) in the same group. The term “facility” refers to hospital settings (including inpatient and outpatient settings, the emergency department, observation care and critical care) and skilled nursing facilities. (Importantly, the Final Rule For Split/Shared Services does not apply to office settings.) The visit is billed by the physician or practitioner who provides the “substantive portion” of the visit.
For 2022, a practitioner is said to have provided the “substantive portion” of the visit if the practitioner either per- forms one of the key components of the visit in its entirety – history, physical examination and medical decision making – or provides services for more than 50% of the total visit time, and upon meeting those criteria can bill for the encounter with a modifier FS. Originally, CMS had stated in the Final Rule For Split/Shared Services that by 2023, the “substantive portion” of the visit was solely to be defined as more than half of the total time spent. In the CY 2023 pro- posed final rule, however, CMS states that it will continue to use the broader definition that also encompasses the practitioner performing one of the key components of the visit.
All medical records must include the identity of the practitioners who performed the visit, as well as the time spent by each practitioner in order to assess who provided the “substantive portion” of the visit. CMS states “any individual who is authorized under Medicare law to furnish and bill for their professional services, whether or not they are acting in a teaching role, may review and verify (sign and date) the medical record for the services they bill, rather than re-document notes in the medical record…” Sufficient medical record documentation is the key to proper reimbursement.
YOU NEED NOT NAVIGATE THIS MURKY LANDSCAPE ALONE
Careful attention to these coding and documentation requirements is critical. Garfunkel Health Advisors can assist you in implementing these new guide- lines correctly and efficiently and in conducting a baseline audit to assess whether your existing system fully complies with the Final Rule For Split/Shared Services.
Should you have any questions regarding the above, please contact Alicia Shickle at alicia@garfunkeladvisors.com, Simon Chaykler at schaykler@garfunkeladvisors.com or (833) 355-1333.
Click Here to download the Alert.