Resolved Medicare guidelines for physician services

[KimM_73717]

I have a provider (MD) who wants to see the patients in his specialty clinic for the initial exam and then pass all visits thereafter to his CRNP in the clinic. Does Medicare require the provider to see the patient at subsequent visits? Also, how in the world do I navigate CMS.org to find this information? Do you have a lesson on CMS.org?

 

[Lori]

In January, CMS introduced guideline changes to its Medicare reporting rules that impact PA/NP billing. These changes could require practices to modify how they report split/shared services. Previously, shared services were frequently reported in the name of a physician. Now, new rules determine who can report the services. Failing to comply with the new CMS rules will create compliance risks for physician practices.

This article outlines what has changed for split/shared billing, as well as what CMS indicates is ahead for 2023.

8 key changes:
1. Split/shared billing—facility setting
2. Split/shared billing—office/clinic settings
3. Defining the substantive portion
4. Criteria for counting time
5. Face-to-face contact
6. Documentation and signature
7. New modifier
8. Prolonged services

https://www.aaos.org/aaosnow/2022/may/managing/managing02/


We do have a video on that topic.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf

● Medicare Claims Processing Manual

100-04 | CMS

www.cms.gov