In the CY 2024 Physician Fee Schedule Proposed Rule (the Proposed Rule), the Centers for Medicare & Medicaid Services (CMS) proposed further delaying their implementation of the time-only definition for determining the “substantive portion” of split/shared Evaluation and Management (E/M) visits in the facility setting until at least December 31, 2024. High profile legal firm, McCarter & English, LLP, discusses this in greater detail.
This delayed implementation, however, does not mean hospitals and legal experts should sit idle in reviewing their split/shared services. They should instead take this opportunity to evaluate their structures and processes to ensure compliance when the proposed rule eventually comes into effect.
According to the Proposed Rule, a “substantive portion” of an E/M visit is defined as a “split/shared” visit carried out between a physician and a non-physician practitioner (NPP). The determination of the substantive portion will shift from the current requirement of directly performed face-to-face services to a time-based definition.
Although CMS continues to move slower than expected on this issue, there have been several key changes implemented for split/shared services throughout this period. This slow pace of change, notwithstanding the delay, provides a window of opportunity for hospitals and legal departments to review and make any necessary changes to their practices, ensuring they are ready when the requirements become effective.
It is crucial for hospitals and legal professionals to stay ahead of these changes and prepare accordingly. Now is the time for reviewing legal processes, training staff, updating policies, and potentially even restructuring the way split/shared services are managed and delivered.
Hospitals and legal professionals need to keep in mind that while CMS may appear to be moving slowly with these changes, the quiet before the storm should not be wasted. It is highly recommended to use this mechanism as an opportunity to fine-tune service delivery models, ensure legal compliance, and anticipate future requirements. This will not only help to mitigate potential legal issues but also facilitate smooth transitions when the new regulations are finally in place.
The review process may seem daunting, but thorough preparation is the key to success in this ever-changing legal landscape. A proactive approach will not only help identify potential issues and mitigate them in advance, but also provide the chance to improve service delivery and efficiency.
This topic and its implications for the wider health industry were addressed in greater detail on the JD Supra website. You can access the full report here.