The Centers for Medicare and Medicaid Services (CMS) revised its guidelines for shared visits, which went into effect on Feb. 15, 2022. A shared visit is defined as a patient encounter where both a qualified advanced practice provider (APP), such as an advanced practice registered nurse (APRN) or a physician assistant (PA), and a physician each provide care to the same patient on the same date of service. As of 2/15/22, the way to decide who will be the billing provider is to determine who provided the substantive portion of the visit.
The “substantive portion” can be either:
a. The provider who documented the medical decision-making in its entirety,
OR
b. The provider who rendered more than 50% of the total time of the visit on the day of the encounter.
Shared visit rules apply to critical care visits. Both the MD and the APP must accurately document their personal time spent providing critical care on the day of the encounter. Overlapping time can only be counted by one provider. For critical care services, the practitioner who renders more than 50% of the total critical care time on the day of the encounter is the billable provider. The time spent in performing billable procedures cannot be counted towards the critical care time.
There have been no changes to the requirements that both the MD and the APP must be employed or leased by Yale Medicine and credentialed with the insurance companies. Modifier (FS) is required on claims to identify shared visits.