In 2024, CPT® expanded its definition of split/shared services, CMS updated their requirements. Neither CMS nor CPT® made changes to this policy in 2025 or 2026. Split/shared services are evaluation and management services (E/M) services performed jointly between a physician and a non-physician practitioner (NPP), also called advanced practice nurses or physician assistants. CMS pays […]
How Physician Services are Paid
Use the resources here to quickly educate new practitioners and staff about coding and reimbursement. You'll find explanations about code sets and compliance, about Medicare incident-to and shared services rules, and requirements for billing for services provided jointly between a resident and an attending.
The Ideal Audit Review Meeting
Do you hope for the perfect audit review meeting? You audit an entire team of providers who either have 100% accuracy or they don’t, but they greet your feedback with grace and humility. It helps when you of direct communication and real curiosity and engagement with the medical team, but results are not guaranteed. Auditing […]
Reimbursement Reality: Navigating the 2026 Payment Landscape | Webinar
Recorded January 15th, 2026
1 CEU Expires 1-30-2027
Guest presenter Elizabeth Woodcock
Change remains the only constant in reimbursement for health care services. Stay ahead in 2026 with this essential payment update for medical practices. This session will break down the latest federal payment policies, emerging reimbursement models, and what they mean for your medical practice’s bottom line.
Teaching Physician Rules | Quick Reference Guide
This quick reference guide breaks down who must document what for which services as outlined in Medicare’s teaching physician rules.
Non-Physician Practitioners in Nursing Facilities
Question: Can a Non-Physician Practitioner (NPP) see patients in a nursing facility without a physician signing each encounter? How do we bill this? Can we do wellness visits in a nursing facility? Answer: Yes, NPPs may care for patients in a nursing home. These can either be billed directly by the NPP, under their own […]
Incident To Services – Medicare
Medicare has specific rules for billing for nurse practitioners and physician assistants and other office staff incident to a physician services in an office. This article includes: Description, explanation and codes for incident-to services Billing and coding rules Brief video overview Enrollment of non-physician practitioners (NPPs) for incident-to billing Pharmacists and Part B Medicare reimbursements […]
NPP Billing-Shared and Incident to Services | Webinar
Recorded November 20th, 2025
1 CEU expires 11/30/26
Guest presenter Seth Canterbury
Billing for services involving NPPs presents specific challenges. This webinar will provide an in-depth review of Medicare’s current rules for services involving advanced practice providers (NPPs), focusing on the distinctions and documentation requirements for split/shared encounters and incident-to billing.
Teaching Physician Rules – Moonlighting
Question: Resident is moonlighting in an urgent care setting. The resident is licensed but not enrolled with insurance companies. Can we follow the Teaching Physician rules for this resident and bill for services jointly performed between an attending and the resident? Answer: For Medicare, no, not based on my reading of the applicable statutes. “Moonlighting” specifically refers to […]
Selecting the Correct Place of Service Code
Pam Warren, MHA, COC, CPC, Fellow We’ve all seen that two-page chart in the CPT® book that indicates the place of service code (POS) that is expected to be reported for physician services. But not every physician performs in office settings; not all physicians perform office visits, and some services can be billed by physicians when […]
Provider-Based Billing | Webinar
Recorded July 17th, 2025
1 CEU expires 7/30/26
Guest presenter Pam Warren of MaineHealth
Reporting services in provider-based clinics requires knowledge of Medicare rules related to the technical and professional components of visits. It requires understanding of both the CMS 1500 form and the UB04.
Billing Physician Services for Hospice Patients | Reference Sheet
Medical practices find the hospice modifiers confusing, and confusion leads to denials and payment delays. Use the decision trees below to help you determine if the service is separately billable once a patient has elected hospice and if so, how to bill it.
Coding Guide – Teaching Physician Rules
The teaching physician guidelines are Medicare rules that allow for payment for services that are performed jointly between a resident and a licensed attending physician (the teaching physician). This downloadable coding guide from CodingIntel provides an explanation of teaching physician rules for E/M services and specialty specific services.
Billing Medical Practice Services for Patients on Hospice
Overview of Hospice Care Additional Services (non-Hospice Organization) Medicare beneficiaries who have a terminal illness with a life expectancy of six months or less can elect to have their end-of-life care provided by a hospice organization (the “hospice”). Medicare then pays hospice to provide all the care that the patient needs that is related to […]
How Fees are Set in the Medicare Fee Schedule
How does Medicare set its fees? This is important for other payers because commercial payers often use the values set by Medicare to calculate their fees. This overview provides information and examples to explain how fees are set in the Medicare Fee Schedule. CodingIntel members can start with the brief video introduction and companion slides, […]
Transforming Patient Collections: Expert Insights and Strategies | Webinar
Recorded October 16th, 2024
Guest Presenter Elizabeth Woodcock
Gain valuable insights on how to effectively respond to industry changes and actionable steps to enhance your revenue cycle management in this engaging webinar centered around navigating the current inflection point in patient collections.
Compliance Guide
You may have heard about the “Seven Elements for an Effective Compliance Plan.” In fact, if you enter that term in a popular web browser “about 575,000” results appear within seconds. Fortunately, compliance and enforcement agencies endorse the elements and provide great examples on what to do – without having to delve much into those […]
Where Does it Say That? | Webinar
Recorded October 9th, 2024
1 CEU expires 10/30/26
Guest Presenter Pam Warren of MaineHealth
This webinar is a guide for auditors and coders looking for regulatory guidance when they are answering coding, compliance and regulatory questions from practitioners and colleagues. This presentation offers common healthcare compliance scenarios and provides the location of the associated guidance.
Developing an Audit Work Plan to Satisfy Your Compliance Program | Webinar
Recorded September 25th, 2024
Guest Presenter Pam Warren of MaineHealth
The OIG identifies seven elements of an effective Compliance Plan. One of them is conducting internal monitoring and auditing. This presentation will look at what to audit, how to evaluate risk, how to set up your audit process, and how to report your results.
CMS’s 2024 Shared or Split Services Policy: Document and Report Them Correctly
In 2024, CPT® expanded its definition of split/shared services, CMS updated their requirements. Neither CMS nor CPT® made changes to this policy in 2025 or 2026. Medicare requires that both practitioners are enrolled in Medicare, and both have E/M in their scope of practice. CPT® expanded its definition of split/shared services in 2024. The service […]
OIG Report on Telehealth During the PHE
What? An OIG report without doom and gloom? Fire and brimstone? Slides In February, 2024 the OIG released an audit report of telehealth E/M services performed between March 2020 and November 2020. During this nine-month period practitioners submitted claims for 19 million E/M services. Before I talk about the report though, let me congratulate everyone […]
Teaching Physician – Primary Care Exception
CMS updated the teaching physician rules in 2019, and this article reflects the change. On April 26, 2019 CMS released Transmittal 4283. The transmittal primarily addresses E/M services, but also amends the section of the manual related to the primary care exception. The changes to the primary care section were mostly wording updates. Those rules […]