The split/shared rule is back with a few alterations. The original rule was promulgated through CMS’ manual system, and dates back to the Carrier’s Manual. CMS has now implemented the rule as a regulation (
42 CFR § 415.140), liberalizing several aspects and restricting different aspects. The new rule expands available settings to include SNFs and nursing facilities, and may now also be applied to new patients instead of just established patients. In our AGG Note, “
Split/Shared Visit Revisions,” we explain the requirements around what constitutes the “substantive portion” of the visit which determines who can bill for the service. Two methods are available in 2022: component-based or time-based. For 2023 and beyond, the “substantive portion” can only be time-based. The split/shared visit rules will form the basis for overpayments and false claims if physicians and their NPPs fail to comply with the rules.