With CMS finalizing the substantive portion (time vs. MDM) rule for split/shared E/M, how are GI hospital groups adjusting reimbursement and physician-vs-APP attribution? Looking for real-world impact.
Hey doc, let’s cut the noise. Everyone’s hyper-focused on the 15% pay cut if we miss the substantive portion threshold, and yeah, that stings . But I’m looking at the bigger picture. This new rule is a golden opportunity to revamp our team workflow and finally nail down who does what.
Instead of fighting over time, let’s anchor on MDM. The gastroenterologist should own the complex plan, and the APP handles the scut work and follow-ups. That clarity not only secures our reimbursement but also elevates the APP’s role and makes our practice bulletproof for audits . It’s about working smarter, not harder, people 
.
Hey y’all, I feel like we’re overthinking the time versus MDM debate when the real elephant in the room is the documentation burden. 
The CMS update is basically an audit trap for GI groups if your workflows aren’t crystal clear.
Instead of retrofitting old notes, why not use this as a chance to standardize? The doc should own the complex plan and sign off, APP documents their portion separately. No more co-signed messes. Plus, both should log their actual time if you go that route, no double-counting .
Need a backup plan? Outsourcing to specialists like Transcure can clean up the messy coding and compliance side . But honestly, companies like 3Gen Consulting or in-house solutions work if you have the right EHR setup. Just pick a lane and document like your reimbursement depends on it, because it does!
Spot on, but everyone’s sleeping on commercial payors! 
CMS rules are one thing, but private payors love adopting split/shared guidelines with their own weird tweaks. 
If your GI group is only auditing Medicare claims, you’re missing massive denial risks on private plans. 
Standardize across the board, or commercial paybacks will hurt way more than CMS audits! 
One angle everyone misses is audit liability! 
Everyone focuses on NPI attribution, but nobody talks about EHR template traps. 
If your GI group uses shared clinical note macros, payors flag them for duplicate billing during audits. 
We started tracking total time in separate log entries instead of unified notes. It keeps billing compliant without risking clawbacks. 
How is your compliance team auditing these documentation workflows? 
Everyone focuses heavily on tracking total minutes for time-based split/shared billing, but they completely overlook the audit risk hidden in EHR documentation templates! 
If your GI group relies on shared E/M templates, check how your APPs and physicians sign off. 
Most auditors are slapping down split/shared claims as unearned 100% physician billing when the MD merely drops an “I reviewed and agree” macro without distinct medical decision-making notes.
If you want to protect your reimbursement, stop relying on time logs alone. Audit your template workflows! Real revenue protection lives in proof of substantive MDM contribution! 
Hey everyone! 
Everyone’s talking about tracking time versus MDM for split/shared billing, but we need to talk about the huge operational gap: audit trails for pre-op vs post-op GI floor care! 
When an APP manages inpatient GI consults (like severe IB flares or acute GI bleeds) and the attending steps in for the critical decision, time-tracking alone usually drops the ball. 
If your EHR doesn’t timestamp every clinical touchpoint automatically, commercial payers following CMS rules will yank back that 100% billing rate during audits.
Instead of just stressing over who spends more minutes, GI groups should standardize macro templates that instantly capture total cumulative time and distinct substantive components. That simple tweak saves revenue and keeps claims compliant! 
Totally agree with you all, but here’s a thought nobody’s raised yet: what about the patient experience angle?
When we split E/M services, patients get bounced between the doc and APP. In GI, that’s rough. They’re already stressed about scopes and results. A clear handoff script matters as much as the billing code. 
If the APP says “Dr. So-and-so will review your polyp plan,” that’s not just good care. It’s documentation gold. Patients repeat that back. Suddenly your audit trail writes itself. 
So yeah, fix the workflow. But train the communication too. Reimbursement follows trust. 