{"id":2004,"date":"2022-02-14T11:57:41","date_gmt":"2022-02-14T16:57:41","guid":{"rendered":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/?p=2004"},"modified":"2023-02-10T14:14:53","modified_gmt":"2023-02-10T19:14:53","slug":"2022-split-shared-visit-changes","status":"publish","type":"post","link":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/2022\/02\/14\/2022-split-shared-visit-changes\/","title":{"rendered":"2022 Split\/Shared Visit Changes"},"content":{"rendered":"<p>Effective January 1, Medicare split\/shared visit guidelines were revised. Medicare defines a split\/shared visit as <strong>an evaluation and management visit in a <em>facility<\/em> setting performed by a physician and a non-physician practitioner (NPP) who are in the <em>same<\/em> group (tax id number). Each practitioner performs components of the visit but only one practitioner bills Medicare for the service.<\/strong><\/p>\n<p>Below is a summary of key changes for 2022:<\/p>\n<ul>\n<li>Split\/shared may now be utilized for:\n<ul>\n<li>new patient visits<\/li>\n<li>initial visits<\/li>\n<li>critical care services<\/li>\n<li>prolonged services<\/li>\n<\/ul>\n<\/li>\n<li>A Split\/shared visit <strong>must be billed by the provider who performs the substantive portion<\/strong> of the visit. The substantive provider is defined as:\n<ul>\n<li>Non-Critical Care: the provider who performs one of the three key components in its entirety (history, exam, medical decision making) <strong>or<\/strong> who provides more than half of the total visit time<\/li>\n<li>Critical Care: the provider who provides more than half of the total visit time<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\"><em>Because Medicare has different payment rates for physicians and NPPs, it is important to correctly identify and bill under the substantive provider. Otherwise, underpayments or overpayments will occur.<\/em><\/p>\n<ul>\n<li>The substantive portion can be comprised of time that is with or without a patient face-to-face encounter.<\/li>\n<li>One of the providers is required to have face-to-face time with the patient but it does not have to be the provider who bills Medicare.<\/li>\n<li>Medicare claims for split\/shared visits are now required to have modifier FS. This will allow Medicare to easily identify, monitor and audit provider split\/shared visit utilization.<\/li>\n<\/ul>\n<p>If you have questions or would like additional split\/shared guidance, please contact the <a href=\"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/contact-us\/\" rel=\"\">Office of Healthcare Compliance and Privacy.<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Effective January 1, Medicare split\/shared visit guidelines were revised. Medicare defines a split\/shared visit as an evaluation and management visit in a facility setting performed by a physician and a non-physician practitioner (NPP) who are in the same group (tax id number). Each practitioner performs components of the visit but only one practitioner bills Medicare [&hellip;]<\/p>\n","protected":false},"author":38,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"wds_primary_category":0,"footnotes":""},"categories":[1],"tags":[],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-05-01 22:40:36","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category"},"_links":{"self":[{"href":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/wp-json\/wp\/v2\/posts\/2004"}],"collection":[{"href":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/wp-json\/wp\/v2\/users\/38"}],"replies":[{"embeddable":true,"href":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/wp-json\/wp\/v2\/comments?post=2004"}],"version-history":[{"count":1,"href":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/wp-json\/wp\/v2\/posts\/2004\/revisions"}],"predecessor-version":[{"id":2462,"href":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/wp-json\/wp\/v2\/posts\/2004\/revisions\/2462"}],"wp:attachment":[{"href":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/wp-json\/wp\/v2\/media?parent=2004"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/wp-json\/wp\/v2\/categories?post=2004"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/health.uconn.edu\/healthcare-compliance-privacy\/wp-json\/wp\/v2\/tags?post=2004"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}