Split and shared services

When an inpatient or observation patient receives care from both a physician and a non-physician provider (NPP) on the same date, provided there is combined documentation, the service can be billed by the physician so he or she receives 100% of the physician fee schedule reimbursement instead of 85%, when the NPP bills for the service alone. Providers who wish to bill in this fashion must remember:

• There needs to be a statement detailing why the patient needed to be seen by a physician after a NPP visit on the same date (medical necessity)
• The patient must have a face-to-face visit with the physician
• The physician must document at least one factor from the evaluation and management requirements, history, physical examination or medical decision-making
• Critical care may not have combined time from both providers (MD and NPP) and may not be billed as a split or shared service
• Consultations may not be billed as split or shared services
• The physician’s contribution to the documentation cannot be an attestation stating that the NPPs documentation has been reviewed and agreed upon

For more information, please contact Vivian Furtado, 203-336-7859, in the Office of Privacy and Corporate Compliance.