Split/Shared Visits and Incident To E/M Services
Description
In this course, the coder will gain a comprehensive understanding of split/shared visits and incident to services, including their definitions, billing requirements, and documentation criteria. The course explores how physicians and non-physician practitioners (NPPs) can collaborate to deliver evaluation and management (E/M) services, with detailed guidance on reporting these services under Medicare and other payers. Key concepts such as the substantive portion, time-based billing, and critical care services are covered, along with the reimbursement implications of accurate coding. By the end of the course, coders will be equipped to navigate these complex scenarios with confidence, ensuring compliance and optimizing financial outcomes.
Included Lessons:
- Options for E/M Service Sharing
- Definitions
- What is a Split (or Shared) Visit?
- Substantive Portion
- Split or Shared Visit Reporting Requirements
- Time-Based Split (or Shared) Visits
- Prolonged Services with Split (or Shared) Visits
- Split (or Shared) Critical Care Services
- Reimbursement Impact
- Incident To Services
- Incident To Services for Pharmacists
- Organization Impact
CEUs available for the following credentials:
AHIMA
CCA, CCS, CCS-P, RHIT, RHIA, CDIP, CHDA, CHPS
Key Takeaways
- Clear Definitions and Roles: Understand the key differences between split/shared visits and incident to services, including when and how each applies. Recognize the roles of physicians and non-physician practitioners (NPPs) in delivering and billing for these services.
- Billing and Reimbursement Mastery: Learn how to correctly report split/shared visits and incident to services to ensure proper reimbursement under Medicare and other payers. Identify the reimbursement impact of coding under a physician’s NPI versus an NPP’s NPI.
- Documentation Expertise: Gain clarity on documentation requirements for split/shared visits, including the use of modifiers like FS and FT. Identify common pitfalls in documentation that could lead to non-compliance or denials.
- Time-Based and Critical Care Coding: Understand how to code split/shared visits based on total time and the substantive portion of services provided. Navigate the unique requirements for coding critical care and prolonged services provided by both physicians and NPPs.
- Incident To Services Insights: Learn the specific criteria and limitations for billing incident to services, including their application in non-hospital-based settings. Explore the role of pharmacists in incident to services and their documentation requirements.
- Compliance Readiness: Develop strategies to ensure coding and billing practices align with CMS and CPT® guidelines, reducing audit risks. Review organizational and payer-specific policies to ensure accurate reporting.
- Improved Financial Impact: Understand the financial implications of proper coding for split/shared and incident to services. Avoid revenue loss by adhering to billing requirements and preventing improper reimbursement.
- Practical Application: Gain practical knowledge on how to assess real-world scenarios, ensuring coders can confidently apply course concepts in their daily work.
Benefits of Taking Course
- Improve Coding Accuracy
- Optimize Reimbursement
- Stay Updated
- Enhance Compliance
- Build Confidence
- Advance Professional Skills
- Increase Career Value
FAQs
What is the difference between split/shared visits and incident to services?
Does the course cover modifier usage, such as FS and FT?
Yes, the course explains when and how to use modifiers like FS (for split/shared visits) and FT (for unrelated E/M visits during the postoperative period or on the same day as another service) to ensure accurate coding and billing.
About our Medical Coding Courses
HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for more than three decades—offers a comprehensive online education platform for medical coders. With a catalog of over 200 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection approved by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPT, E/M, ICD-10-CM, ICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatient, outpatient, profee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CM, ICD-10-PCS, CPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams.
Overview
.png)