Category: Medicare Billing & Coding
Split/Shared Visit Billing Rules: Who Bills When a Physician and an NPP Share One Visit
Split/shared visit billing rules let a physician and a non-physician practitioner in the same group share one facility E/M visit, billed once by whoever performed the substantive portion: more than half the combined time or the substantive part of medical decision making. Medicare requires modifier FS, a record naming both clinicians and the billing practitioner’s […]
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Incident-To Billing Rules for NPs and PAs: 2026 Medicare Guide
Incident-to billing rules for NPs and PAs are Medicare conditions that let a nurse practitioner’s or physician assistant’s office service be billed under a supervising physician’s NPI at 100% of the fee schedule. The service must follow a physician-initiated plan of care, occur in a non-institutional setting, and be performed under direct supervision. When any […]
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Medicare Advantage Billing Guide: 2026 Rules for Claims, Prior Auth and Appeals
A Medicare Advantage billing guide explains how to bill Part C plans, which are private plans that pay most Medicare-covered services instead of Original Medicare. Claims go to the MA plan, not the MAC, using the plan’s member ID. Since January 1, 2026, MA plans must decide expedited prior authorizations within 72 hours and standard […]
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Mastering Medicare Billing: The Definitive Guide for Providers
For healthcare providers, Mastering Medicare Billing is not just an administrative goal—it is a critical financial imperative. The complexities of the Medicare program, with its ever-evolving CMS billing guidelines, present a significant challenge for practices of all sizes. Inefficient Medicare claims processing leads to delayed reimbursements, claim denials, and potential compliance risks. This definitive Medicare billing guide is designed to transform your […]
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