Navigating the complexities of healthcare billing is essential for maximizing revenue and maintaining compliance. This intermediate-level webinar, led by Dawson Ballard Jr, RHIA, CCS-P, CPC, CEMC, CEMA, AAPC Fellow, provides a comprehensive exploration of incident-to and split/shared services—two critical concepts in medical billing and coding. Attendees will gain a clear understanding of the definitions, requirements, and distinctions between incident-to and split/shared services, with a focus on the latest CMS rules and regulatory updates. The session will cover eligible providers and settings, supervision requirements, and the importance of accurate documentation, including tracking time and medical decision making (MDM).

Through real-world scenarios and practical examples, participants will learn how to determine the “substantive portion” for split/shared services and apply appropriate modifiers (FS, FT) to optimize billing. The webinar will also address common compliance mistakes, audit risks, and strategies to avoid denials, ensuring attendees are equipped to maximize reimbursement and operational efficiency. Designed for coders, billers, CDI professionals, revenue cycle specialists, and providers, this training delivers actionable insights and best practices to support compliant, effective billing in today’s evolving healthcare landscape.

Educational Objectives:

• Define and distinguish between incident-to and split/shared services, including their unique requirements and billing implications
• Interpret the latest CMS rules and updates for incident-to and split/shared services, focusing on compliance and regulatory changes
• Identify eligible providers and settings for each billing type, such as physicians, non-physician practitioners (NPPs), and various healthcare environments
• Explain supervision requirements for incident-to billing versus split/shared services, and how these impact workflow and compliance
• Demonstrate proper documentation practices to support compliant billing, including tracking time, medical decision making (MDM), and provider roles
• Apply the concept of the “substantive portion” in split/shared services, using time or MDM to determine billing responsibility
• Recognize common compliance mistakes and audit risks and implement strategies to avoid denials and maximize reimbursement
• Utilize real-world scenarios and modifiers (FS, FT) to accurately bill incident-to and split/shared services, optimizing revenue and operational efficiency

Areas Covered in the Session:

• Incident-To
• CMS Definition
• Source
• The Basics of “Incident To” Billing
• Documentation
• Incident-To Clinical Scenarios
• Split/Shared E/M Services
• Code is Determined Via Two Options:
  • Total time on date of service
  • Substantial portion of MDM
• Substantive Portion – Critical Care
• Additional Guidance
• Split Shared Services – Scenario #1
• Visit note is documented in its entirety by the non-physician provider
  • Attestation statement
  • Which Provider Should Bill The Service?
  • The case for the physician:
  • The case for the non-physician provider
  • The verdict
  • The reasons
• Split Shared Services – Scenario #2
  • Physician documentation:
  • Which Provider Should Bill The Service?
  • The case for the physician
  • The case for the non-physician provider
  • The verdict
  • The reasons

Who Will Benefit:

• Physicians
• Physician Assistants
• Nurse Practitioners
• Certified Nurse Midwives
• Providers
• Medical Coders
• Medical Billers
• CDI Professionals
• Compliance Officers
• Revenue Cycle Professionals
• Revenue Cycle Staff
• Practice Managers
• Hospital Administrators