Deconstructing the 2023 Split Shared Services Updates
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The document outlines the 2023 updates for split/shared services in healthcare, focusing on billing, documentation requirements, and financial implications. It explains that split/shared services involve collaborative visits between physicians and non-physician practitioners in facility settings, and distinguishes these from incident-to reporting. Key changes, financial impacts, and education strategies for providers and coders are also discussed.
Deconstructing the 2023 Split Shared Services Updates
- 1. Deconstructing the 2023 Split/Shared Services Updates PRESENTED BY: TONI ELHOMS, CCS, CPC, CPMA, CRC, AHIMA- APPROVED ICD-10-CM / PCS TRAINER 1
- 2. Toni Elhoms, CCS, CPC, CPMA, CRC, AHIMA Approved ICD-10-CM/PCS Trainer ❑ CEO – Alpha Coding Experts ❑ Podcast Host – Alpha Coding Podcast ❑ National Speaker - Coding, Compliance and Reimbursement SME ❑ Former President of Orlando, Florida AAPC Chapter ❑ Expert Witness ❑ Published Author ❑ Consultant/Educator/Trainer 2
- 3. Agenda Deconstruct the key 2023 split/shared service updates Discuss appropriate split/shared service billing and NPI reporting protocols Discuss new clinical documentation requirements for split/shared encounters Deconstruct the financial impact of 2023 split/shared service updates Review various split/shared service case studies and coding rationale together Q&A at the end 3
- 4. Split/Shared Services ❑ Split/Shared E/M visits = shared service between a physician and a non-physician practitioner (NPP) in a facility setting ❑ Physician and NPP must be in the same group ❑ Not applicable in the office or other outpatient setting ❑ Facility – hospital or SNF ❑ Documentation must identify the two individuals (physician and NPP) who performed the visit ❑ The physician must actually see the patient in order for the encounter to qualify for split/shared 4
- 5. Split/Shared Services ❑ Split/Shared is NOT the same rule as incident-to reporting ❑ Co-signatures do not constitute split/shared services ❑ Incident to – the services or supplies are furnished as an integral, although incidental, part of the physician’s personal professional services during DX or TX of an injury or illness ❑ Applies to office setting only ❑ Established patient with established problem(s) with established plan of care 5
- 6. Split/Shared Services ❑ Split/Shared E/M visits = facility based E/M ❑ Admissions ❑ H&Ps ❑ Rounds ❑ Critical Care ❑ Prolonged Services ❑ SNF visits (outside of any required physician-specific services) 6
- 8. 2023 E/M Guidelines ❑ MDM - straightforward, low, moderate, high complexity ❑ Number and complexity of problems addressed ❑ Amount and/or complexity of data to be reviewed and analyzed ❑ Risk of complication and/or morbidity or mortality of patient management ❑ Total Time on the encounter DOS 8
- 9. Financial Impact ❑ 99233 billed under physician’s NPI # = $102.43 – MPFS ❑ 99233 billed under NPP’s NPI # = $87.06 – MPFS ❑ Differential = $15.37 ❑ Apply to 20 patients per day = $307.40 per day ❑ Apply to 100 patients per week = $1537 per week 9
- 10. Education Tips ❑ It’s a LOT to keep track of and overwhelming! ❑ Use Pocket-Guides, Tip-Sheets, Coding Matrix ❑ Map out most common scenarios with the provider’s own clinical documentation ❑ Establish a consistent feedback loop ❑ Audit. Educate. Rinse and Repeat! 10
- 11. Who is Impacted? Physicians/NPPs/ Other Healthcare Providers Revenue Cycle - Coders/Billers/Auditors Physician/Provider Compensation Professionals Compliance Professionals EMR/PM Vendors 11
- 12. Workflows Impacted Clinical Documentation Templates/Forms Physician/Provider Compensation Workflows Coding/Billing/Auditing 12