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 breaks down the complexities of split/shared billing and provides clear, practical guidance for providers, coders, auditors, and compliance professionals.

Participants will learn:

• When split/shared visits are appropriate
• How to determine and document the substantive portion
• How to bill under the correct provider

It also covers key differences with incident-to services and common pitfalls that lead to denials, recoupments, and audit findings.

Through real-world scenarios, attendees will get tools to align documentation, coding, and billing with current CMS requirements.

Learning Outcomes

• Define split/shared visits and explain when Medicare allows their use
• Identify CMS requirements for split/shared billing (settings and provider roles)
• Understand and apply the substantive portion requirement (Time vs. MDM)
• Differentiate split/shared visits from incident-to and other billing scenarios
• Recognize proper documentation requirements
• Identify common compliance risks and audit triggers
• Apply correct billing practices (provider selection and claim submission)
• Implement workflow and documentation strategies for 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 (Physicians, PAs, NPs, CNMs)
• Medical Coders & Billers
• Auditors & Compliance Professionals
• CDI Professionals
• Revenue Cycle Staff & Practice Managers
• Hospital Administrators
• Legal and Regulatory Teams