Billing and Documentation

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  • 1.  Split/Shared Billing

    Posted 11-30-2022 18:42
    Hi all,
    I work in a large academic medical center are re-examining our current critical care billing workflow and wondering practices in other institutions.

    1. Do the APPs bill critical care time independently or split/shared? If they are billing independently, how do you currently distribute the billing responsibilities between APPs and attendings on the same team?    

    2. Has anyone moved from APPs and MDs billing critical care time independently to split/shared with the new CMS rules and if so, what has the impact been (financial, workload, etc)?

    Erika Wilson
    Critical Care Medicine Advanced Practice Provider Manager
    University of California San Francisco Medical Center
    San Francisco CA

  • 2.  RE: Split/Shared Billing

    Posted 12-02-2022 13:08

    We are currently billing using follow on rules not split shared. Per our MAC we divide the time into physician and APP lanes then divide the time per the critical care rules. In terms of distributing responsibilities:
    1. If the team has resident physicians then the attending bills on those patients
    2. APPs bill on their own patients. 
    3. For time during rounding, the attending bills that time and the APP does not. 
    4. The attending will also bill time separately during the day making sure it the time is not concurrent. 

    We used shared billing for the non-critically ill patients. We are currently using the older rules but will likely move to the new rules next year. This will have a slight (<2%) impact on our billing. 

    David Carpenter, PA-C
    Co-director Quality and Patient Safety
    Emory Critical Care Center 

    David Carpenter
    Co-Director Quality and Patient Safety Emory Critical Care Center
    Emory University Hospital
    Atlanta GA