Description

Are you confident your organization is billing split/shared visits correctly—or could you be at risk for compliance issues and audit exposure?

Split/shared visits have become an area of increased scrutiny, especially with evolving CMS guidance and clarification around the substantive portion requirement. This session is designed to break down the complexities of split/shared billing and provide clear, practical guidance for providers, coders, auditors, and compliance professionals.

Participants will gain a comprehensive understanding of when split/shared visits are appropriate, how to determine and document the substantive portion, and how to ensure services are billed under the correct provider. We will explore key differences between split/shared visits and other billing scenarios, including incident to services, and highlight common pitfalls that lead to denials, recoupments, and audit findings.

Through real-world scenarios and practical examples, this session will equip attendees with the tools needed to align documentation, coding, and billing practices with current CMS requirements.

Stay ahead of regulatory expectations, reduce compliance risk, and ensure your team is accurately capturing and reporting shared services.

Learning Outcomes

• Define split/shared visits and explain when Medicare allows their use.
• Identify CMS requirements for split/shared billing, including applicable settings and provider roles.
• Understand and apply the substantive portion requirement based on current CMS guidance.
• Differentiate split/shared visits from incident to services and other billing scenarios.
• Recognize documentation requirements necessary to support compliant billing.
• Identify common compliance risks and audit triggers associated with split/shared visits.
• Apply correct billing practices, including provider selection and claim submission.
• Implement workflow and documentation strategies to support accurate and compliant shared visits.

Areas Covered in the Session

• Definition and Overview of Split/Shared Visits
• CMS Guidelines and Regulatory Updates
• Substantive Portion Requirement Explained (Time vs. MDM)
• Eligible Providers and Appropriate Settings (Facility vs. Non-Facility)
• Documentation Requirements and Best Practices
• Billing Under the Correct Provider (Physician vs. NPP)
• Common Errors and Compliance Risks
• Differences Between Split/Shared and Incident To
• Audit Considerations and OIG Focus Areas
• Real-World Case Scenarios and Application
• Live Q&A Session

Recommended Participants

• Healthcare providers
• Medical Coders
• Billers
• Auditors
• Compliance Professionals
• Administrative staffs
• Hospitals and Health Systems
• Physician-based practices
• Legal and Regulatory Teams
• Physicians
• Physician Assistants
• Nurse Practitioners
• Certified Nurse Midwives
• Providers
• Medical Billers
• CDI Professionals
• Compliance Officers
• Revenue Cycle Professionals
• Revenue Cycle Staff
• Practice Managers
• Hospital Administrators