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Shared Visit Documentation and Reporting

Posted on February 22, 2019 by CPC Exam Medical Coding Updates

A split or shared visit occurs when both a physician and a qualified non-physician practitioner (NPP) meet face-to-face with a Medicare patient on the same date of service, and the work of the physician and the NPP are “combined” into a single E/M service. Split or shared visits may improve a physician’s productivity and positively […]

The post Shared Visit Documentation and Reporting appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Critical Care vs. Split Shared Services

Posted on January 11, 2019 by CPC Exam Medical Coding Updates

Good Afternoon,
Here is a question for the group concerning billing critical care services. The scenario is: a mid-level sees the patient in critical care. The physician comes into the room at some point with the mid-level. He takes over the service, performing the all aspects of the 99291, documents, makes edits to the mid-levels documentation, adding his own and signs off. I explained the nuances of the split-shared visits and that you cannot bill critical care as a split shared visit. The response back was it is not technically split/shared as the physician, he is doing all the work, just not needing to re-document all of the aspects of the note. The time billed in support of the code is his time only. The question presented to me was why, if he is acting independently, performing the visit and noting only his time, cant he bill the CC charge? The thought was perhaps there is an attestation that he might be able to use to clarify and support billing, by stating the visit was performed in entirety by the physician. i.e. I personally and individually spent X amount of time with the patient performing..
I presented the CMS guidelines. I need to be able to clarify for him why this does not or maybe there is a loop hole, I dont know. If someone can tell me some helpful instruction to provide I would appreciate it.

Thank you,

Andrea R. Altensey, RHIT, CPCO, CCS-P, CPC, CHAP
Sr. Compliance Coding Auditor
[email protected]

Medical Billing and Coding Forum

ICD Shared Decision Making Requirements

Posted on December 21, 2018 by CPC Exam Medical Coding Updates

Hi All
According to this NCD, every patient receiving an ICD for primary prevention will be required to have an encounter for shared decision-making using an evidence-based decision tool.

1) My Physicians are wondering what type of tool they should be using. Do you have any recommendations?

2) How do we document this? Is it something you cover in an office visit and put your discussion in the office note?

3) Do we have to scan something specific in the patients chart?

Thank you!

Medical Billing and Coding Forum

ICD and Watchman shared decision making

Posted on September 12, 2018 by CPC Exam Medical Coding Updates

Does anyone have any information on the documentation requirements for shared decision making for Watchman and ICD implants? Thanks in advance for any help.

Carol Hodge, CPC, CDEO, CCC, CEMC

Medical Billing and Coding Forum

Region 4 – Shared Visits

Posted on August 24, 2018 by CPC Exam Medical Coding Updates

Advanced practice practitioners (APPs) may perform and bill for Evaluation and Management (E/M) encounters separately from a physician. The Medicare Claims Processing Manual further defines APPs as: nurse practitioner (NP), physician assistant (PA) clinical nurse specialist (CNS), or certified nurse midwife (CNM). For some encounters physicians may elect to split or share the encounter with […]
AAPC Knowledge Center

shared decision making for ICD / NCD 20.4

Posted on July 25, 2018 by CPC Exam Medical Coding Updates

We are trying to get a prompt into our system for CPT 33249 that reminds our physicians to document that a formal shared decision making encounter occurred with the patient before ICD insertion.

Under the new Medicare Decision, should the physician also have a shared decision making encounter before placing a left ventricular lead (CPT 33225) for CRT therapy/bi-ventricular pacing?

Thanks in advance for your help.

Medical Billing and Coding Forum

NPs using shared notes for E/M visits

Posted on June 28, 2018 by CPC Exam Medical Coding Updates

If an NP starts a note, shares the note with another NP via EPIC, and the second NP completes the note – is this billable by the second NP??

Medical Billing and Coding Forum

E/M Update Opinions Shared at Listening Session

Posted on April 6, 2018 by CPC Exam Medical Coding Updates

A representative from the Hospital and Ambulatory Policy Group at the Centers for Medicare & Medicaid Services (CMS) held a listening session regarding proposed updates to the documentation guidelines for evaluation and management (E/M) services on March 21st. The listening session was to get feedback from stakeholders on policy proposals for upcoming notice and comment […]
AAPC Knowledge Center

A Medicare Shared Savings Program Success Story

Posted on February 27, 2018 by CPC Exam Medical Coding Updates

Health Leaders Media

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November 4, 2015

A Medicare Shared Savings Program Success Story

Rene Letourneau, Senior Editor for HealthLeaders Media

About a quarter of the ACOs in the MSSP program earned a total of $ 341 million in payouts. Among them is Delaware Valley Accountable Care Organization, whose CEO shares tips for success. >>>

Editor’s Picks

Two-Midnight Rule Changes Cemented by 2016 OPPS Final Rule

Under the final OPPS rule, if the expected duration of care will span less than two midnights, inpatient admission may be allowed on a case-by-case basis determined by the judgment of the admitting physician. >>>

M&A Roundup: Ascension to Acquire Wheaton Franciscan Health, Walgreens Buying Rite Aid

The Wheaton acquisition strengthens Ascension’s market share in Wisconsin. Meanwhile, federal antitrust scrutiny of the Walgreens-Rite Aid combination is likely to come down to a city-by-city review. >>>

Building the Data Analytics Team

Leaders are finding that recruitment from the outside can be useful but difficult, and that internally, talent can be developed to support analytics efforts. >>>

BCBS Ups its National Data, Care Coordination Game

A pair of announcements from the Blue Cross Blue Shield Association demonstrates its commitment to arming employers, providers, and members with a great wealth of quality and cost data to inform their healthcare decisions. >>>

ACEP: Better Ways to Treat Super-utilizers

For emergency department patients who are either lost to or failed by the system, conventional healthcare is about as uncoordinated as possible. New data-sharing and respite programs may help. >>>

The Population Health Commitment

While leaders recognize the value of a new healthcare model, they are still early in forming strategies and making investments. >>>

Medicare Advantage: Room for Improvement

The idea that Medicare Advantage could reduce costs through better care coordination hasn’t played out as intended, says the executive director of the Medicare Payment Advisory Commission. From Medpage Today. >>>

LIVE Webcast

Webcast: Integrating Behavioral Health—Decreasing Costs and Improving Care

Date: November 17, 2015, 1:00–2:00 p.m. ET
In this expert webcast, hear how Carolinas HealthCare System developed a strategy to optimize resources to create a truly integrated model.
Register Today >>>

News Headlines

CA fines top health insurers for overstating Obamacare networks

Los Angeles Times, November 4, 2015

Why health co-ops are closing in so many states

Governing, November 4, 2015

Welcome to the cloud hospital, where big data takes on mysterious medical conditions

Fast Company, November 4, 2015

Kaiser to buy stake in Dignity Health hospital

San Francisco Business Times, November 4, 2015

Health insurers struggle to profit from ACA plans

MarketWatch / The Wall Street Journal, November 3, 2015

TX’s changing relationship to Obamacare

NPR / Houston Public Media, November 3, 2015

TX doctors wary of Aetna-Humana merger

Houston Chronicle, November 3, 2015

BJC HealthCare cracks down on out-of-network patients

St. Louis Post-Dispatch, November 3, 2015

Medicare cuts back work of auditors probing improper payments to hospitals

The Wall Street Journal, November 2, 2015

Prices, politics challenge health law’s 3rd sign-up season

The Charlotte Observer / Associated Press, November 2, 2015

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From HealthLeaders Magazine

Rural Healthcare and the Challenge of Population Health

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Need Opionion on Shared Services

Posted on January 27, 2018 by CPC Exam Medical Coding Updates

I would like to get a second opinion on whether or not this is enough documentation to code under the physician’s NPI? The NP provided a very detailed note and stated that she and the doctor both saw the patient.

"I personally saw and examined the patient with ARNP in heme onc div. Please review her note for complete details.
Patient has been diagnosed with metastatic gastric cancer and agreed to proceed with therapy.
Also plan to do PRN paracentesis for malignancy ascites."

Thanks
KJLamm, CPC

Medical Billing and Coding Forum