Issue link: https://viewer.e-digitaledition.com/i/1439655
CMS IS UPDATING its policies and billing practices to bet ter r e f l e c t t h e r o l e non-physician prac- titioners (NPPs) have in providing care in the facilit y setting. The changes do not apply to physician offices because the incident-to-billing policies a lready in place in that setting reflect the significant role NPPs play in patient ca re. A selection of the policy changes, which take effect Jan. 1, 2022, are summarized below. SPLIT EVALUATION AND MANAGEMENT VISITS Split (or shared) eva luation and man- agement (E/M) visits are now defined as an E/M visit in the facility setting (e.g., a hospita l or skilled nursing facilit y) when such visit is performed in part by a physician and in part by an NPP who are members of the same group, such as being employed by the same employer. Only the physician or NPP who per- forms the "substantive portion" of the split (or sha red) visit may bill for the visit. Beginning in 2023, "substantive por tion" will be defined as more tha n ha lf of the tota l time spent by the phy- sician and NPP performing the split (or shared) visit. Medical groups will undoubtedly face administrative challenges in efficiently and effectively recording the time spent by each physician and NPP during a split (or shared) E/M visit. Therefore, CMS has designated 2022 as a transition year, in which a broader definition of substantive portion will be used with the exception of critical care visits, which will use more than half the total time definition. The 2022 definition of "substantive por- tion" is either more than half of the total time of the visit or a complete performance of any of the three key components of an E/M visit (history, physical exam and medical decision-making). This broader definition should give medical groups sufficient time to develop and implement procedures to ensure accurate tracking of physicians' and NPPs' time. The medical record must also identify the individuals who performed the visit and must be signed by the physician or NPP who performed the substa ntive por tion of the visit. Split (or sha red) E/M visits can be reported for both new and established patients, and for initial a nd subsequent visits a nd prolonged services. A modifier to identify split (or shared) E/M visits must also be added to the claim. The modifier is intended to inform future CMS policy and ensure medical practice compliance with the new regulation. PHYSICIAN ASSISTANT (PA) BILLING A s requ i red by S e c t ion 4 03 of t he C on s ol i d a t e d A ppr opr i a t ion s A c t , CM S updat ed t he requ i rement s for PA bi l li ng a nd pay ment . Prev iously, Medicare could only pay a PA's employer or contractor for ser vices rendered by the PA . Beg inning in Ja nua r y, PA s ca n bi l l Med ica re d i rect ly a nd rea ssi g n payments for professiona l ser vices. This cha nge a lig ns PA billing prac- t ices u nder Med ica re w it h t hose of ot her N PPs li ke nurse practitioners a nd clinica l nurse specia lists who ca n bill Medica re a nd be pa id directly for t hei r ser v ices. Th is new policy may r e q u i r e p r a c t i c e s t o c h a n g e t h e i r Medica re enrollment process for PA s. For example, PAs may need to complete enrollment forms to reassig n payment for their ser vices to their employer. Practices should be mindful that while a PA ca n now bi ll Medica re directly, their ser vices a re only covered when furnished in accordance with state law, including any supervision requirements, and within the PA's scope of practice. n Sarah Steinmann is an a ssociate at CCBLaw, a boutique law firm focused on providing counsel to physicians and other healthcare professionals. She can be reached at 315-477-6232 or ssteinmann@ ccblaw.com. Key Updates to the Medicare Physician Fee Schedule for 2022 THE CENTERS FOR MEDICARE & MEDICAID SERVICES RElE A SED A FINAl RUlE IN NOVEMBER, IMPlEMENTING POlICY CHANGES TO MEDICARE PAYMENTS IN 2022. BY SARAH STEINMANN 1 6