Description:

Incident to and shared care services are two billing methods used in healthcare. Incident to and shared care are specific Medicare billing policies; other payers follow these rules. The incident has existed for many years, whereas shared care is a recent CMS billing opportunity. Compliance is the word of the decade, which means playing by the rules, and the rules can be inconsistent between payors, unpublished or unclear, and change often.

The “Incident to” billing method is commonly used in the United States. It allows a non-physician healthcare provider, such as a nurse practitioner physician assistant, to provide services under the direct supervision of a physician. In these cases, services are billed under the physician’s name, and reimbursement rates may be higher than if billed by the non-physician provider.

“Shared care” involves multiple healthcare providers working together to provide comprehensive care to a patient. Each provider may bill for their services within their scope of practice. This can occur when a patient is under the care of a primary care physician and a specialist, and they collaborate on the patient’s treatment. Billing for shared care services should be done accurately, ensuring that each provider bills for the services they have provided.

Healthcare providers need to be aware of the specific billing rules and guidelines. Additionally, staying up to date with changes in healthcare reimbursement policies is essential to avoid billing errors and potential legal issues.

All physician groups that employ QHPs may be faced with billing Medicare for their services. The critical issue is differences in reimbursement based on who reports a service.

• Medicare reduces QHP billed services by 15% of the physician-allowed amounts.
• Huge compliance issue

Failure to comply with the “incident to” rules can lead to issues ranging from:

• Claims denials
• Overpayments /paybacks
• Future pre-and/or post-payment review
• False claims liability

Webinar Highlights:

• Define QHP providers and meet eligibility requirements to be credentialed by Medicare and bill independently.
• Identify clinical staff and the services they can provide.
• Understand which services require orders.
• Explore the difference between “incident to” and shared care services.
• Review specific guidelines for each service.
• Understand reimbursement issues.
• Look at how other payers view these Medicare. 
• Recent changes to the incident and shared care services.
• Require a certain percentage and establish limits on the number of PA charts.
• Supervising NPP and collaborating contracts should be renewed.
• Scope of practice determined by supervising/ collaborating physician at the practice site. 
• UHC allows “incident to,” and shared care billing may require modifier –SA for incident to services
• CMS states that the service should be reported by the clinician who performs the substantive portion of the visit.
• Review changes to supervision of incidents to services when the public health emergency (PHE) Ended. 
• Private payer interpretations of CMS policies.
• Reimbursement considerations.

Why Should You Attend:

Billing for these services can be complex, involving different rules and guidelines. It provides official coding and billing guidelines from organizations such as the American Medical Association (AMA) or the Centers for Medicare and Medicaid Services (CMS) for detailed information on how to bill for incidents and shared care services and help physician billers correctly report both types of services. The physician or practitioner who spent the substantive portion will bill for the primary E/M visit, and the prolonged service code and other requirements to bill for split or shared services are met.

Who Should Attend:

• Providers
• Coders
• Auditors
• Clinic managers
• Denial management staff
• Accounts payable staff

Presenter Information:

Name: Jan Rasmussen

Jan Rasmussen, PCS, ACS-OB, ACS-GI, – As a health care consultant Jan has more than 45 years of experience in physician billing, reimbursement, and compliance. Jan is currently the owner of Professional Coding Solutions, a healthcare consulting firm. She has been a Certified Professional Coder (CPC) since 1992. As a member of the American Academy of Professional Coders (AAPC) Jan previously served on their Advisory Board as the liaison to the AMA, has been a speaker for the AAPC annual conference as well as contributed to the development of the original AAPC’s independent study, university education programs, and proficiency tests. In 1994, she was honored by AAPC as Networker of the Year.  Jan was also a Regional Governor for the American College of Medical Coding Specialists (ACMCS) serving as Chair of the Ethics committee and a member of the Examination committee.

In her role as a physician consultant, she has participated in physician coding and documentation reviews including OIG government PATH and Campus audits, and designed and conducted physician coding seminars nationwide. She has been a guest speaker for several conferences sponsored by United Communications, Inc//Decision Health, AAPC as well as Coding Institute Specialty Conferences.

In previous consulting positions, she was responsible for developing and conducting seminars for basic, intermediate, and advanced ICD-9-CM and CPT, teaching physician guidelines as well as special seminars for OB/GYN, Orthopedics, Urology, Gastroenterology, General Surgery, ENT, Cardiology, Emergency Medicine and Evaluation and Management. In her role as an educator, she has been teaching E/M documentation and auditing to both physician and coding audiences since 1992 when RBRVS was first implemented.

Jan has also worked for several major health insurance payers in Wisconsin, was a coding advisor to the WPS Medicare Carrier Advisory Committee, and served as the coding and reimbursement coordinator for a 37-provider, staff model HMO clinic.  As the coding and reimbursement coordinator, Jan was responsible for physician office, hospital, surgical, and nursing facility coding charge ticket development, fee development, reimbursement analysis, claims analysis, and physician education.