Split billing refers to certain AHCIP medical billing scenarios where 2 physicians “split” a billing encounter. These billing situations can cause confusion between physicians and rejection of your billing codes from AHCIP. In this post, we are going to review:
What happens when I ‘split’ a case with another physician?
Who usually submits the split bill?
How do I submit claims for split billing?
How do I keep track of these type of split cases?
How do I figure out how payments for the case should be divided?
What happens when I ‘split’ a case with another physician?
Split billing refers to scenarios where one physicians takes over and completes a medical procedure started by a different physicians. In certain cases, AHCIP will only recognize 1 bill from 1 physician. If two separate claims are enter by different physicians for the same procedure on the same patient, the claims can be rejected. For both physicians to be paid, the physicians will need to agree to a split billing.
Who usually submits the split bill?
For a split bill, usual only 1 physician submits the claim, although we discuss both options below. There are no rules on who submits the claim to AHCIP. Typically, we see the physician who initiated the service submitting the claim.
How do I figure out how payments for the case should be divided?
There are no AHCIP rules about how payments should be split, so the approach is up to the physicians. Here is a description of the method we see used most often:
Split Bill based on Time
Generally, we see physicians splitting claim payments based on the actual time or call units each physician worked. For example, consider a case where two Anesthesiologists perform an Appendectomy on a weekday:
Physician A 1100 – 1230
Physician B 1230 – 1330
Split Bill with encounter surcharges and modifiers – If there are time modifiers, they are generally divided based on the hours each physician worked and if there are encounter surcharges, they usually go to the initiating physician. Consider a case where two Anesthesiologists provide care for an extended traumatic injury to major vessels of the trunk, case starting at 1800 on a weekday:
Physician A 1800 – 2200
Physician B 2200 – 0400
The total billings in this scenario are: 51.3 A @ 2ANES x 120 calls + EV encounter surcharge + TEV16 + TNTP08 + TNTA16. If the bill is split via the method above, the result is the following:
Physician A = 51.3 A (2ANES x 48 calls + EV encounter surcharge + TEV16
Physician B = 51.3 A (2ANES x 72 calls + TNTP08 + TNTA16)
Note this split is determined by the physicians and these calculations need to be made by the physicians or their biller.
The method we describe here is the approach we see most frequently used. However, physicians can split via any method they agree upon. For simplicity, some physicians choose to just split the bill in half. Whatever splitting method you select, be sure that both physicians have the same understanding of how the bill will be split.
How do I submit claims for split billing?
A split billing can be accomplished one of two methods. One physician can submit the claim and share the compensation with the other physician(s). Alternatively, each physician can submit their own claim for the portion in which they work to AHCIP with correct supporting text identifying the claim as a split billing case.Let’s consider the two options:
1. One Physician submits the billing claim, then compensations the other physician
In this method, the first physician takes ownership of the billing and submits on behalf of both physicians. Once the billing physician is paid, they share the billing with the other physicians. Let’s looks at our example from above with two Anesthesiologists performing an Appendectomy:
Physician A 1100 – 1230
Physician B 1230 – 1330
The total billings in this scenario are: ANEST x 30 units (Physician A = ANEST x 18/ Physician B = ANEST x 12). However, if Physician A bills ANEST x 18 to Alberta Health and Physician bills ANEST x 12 to Alberta Health, there will be a billing rejection. Alberta Health will refuse payment if each physician submits the same codes for the same patient on the same day. The second claim will appear as a “duplicate claim” in Alberta Health’s system causing a rejection.
To avoid this rejection, Physician A will bill ANEST x 30 units to Alberta Health, noting that they are owed ANEST x 18 and they will collect ANEST x 12 on behalf of Physician B. Once the claim is paid, Physician A will pay ANEST x 12 units to Physician B privately.
2. Both physicians submit separate billing claims with supporting text
An alternative way to bill for split cases, would be that each individual physician submits their portion of the claim to AH. If you choose this method, both anaesthetists must provide supporting text in their claims, clearly indicating the time in which they cared for the patient, and explanation of the scenario, and reference the other anesthesiologists involved. For some physicians, this is the simpler method to submit a split billing as it does not require any post-claim payment between physicians. It also simplifies your accounting and ensure income summary reports are accurate. However, if this supporting text is not provided by both physicians, the second claim to be received by Alberta Health will be considered a duplicate entry and not be paid, so it is important to coordinate your colleagues.
How do I keep track of split cases?
Keeping track of split billings can be a hassle and a source of friction. For split cases, we advise physicians to keep clear notes on a claim to track the times and physicians with whom they split cases. Make sure the arrangement of how to split the claim is clear with the other physician. For Statgo users, you can add an internal note to the claim. When payment is confirmed you can either calculate the split yourself or flag the claim in the system and one of our agents will calculate the split and forward you this information.
And that is split billing! If you have questions regarding split billing our agents are always happy to help. Send us an email or note in the Statgo software and we’ll help guide you through the process. If you’re not a Statgo client, send us a message and we’ll be happy to help.