Billing and Documentation Update-Billing and Documentation Update

Video Transcription

Video Summary

The webcast, moderated by anesthesiologist Dr. Piyush Mathur and presented by billing and coding expert Jill Young, provided an in-depth update on 2026 Medicare Physician Fee Schedule rules and critical care billing/documentation. Key topics included the dual conversion factors for Accountable Care Organizations versus others, removal of certain telehealth visit frequency limits, and expanded virtual supervision allowances for non-physician practitioners. The Office of Inspector General’s audit findings highlighted prevalent issues with insufficient or incorrect documentation in critical care claims, which contribute to improper payments estimated at over $213 million in 2024.<br /><br />Jill stressed that critical care billing demands documentation evidencing severely ill patients with acute organ failure and high-complexity decision-making—not simply ICU admission or monitoring. Multiple providers of the same specialty within the same group can cumulatively count time spent, enabling more accurate billing. However, CMS and CPT definitions differ on time thresholds for secondary critical care codes, complicating billing strategies. The importance of modifiers for split/shared visits and teaching physician documentation was emphasized to ensure compliance and maximize claims.<br /><br />Through real case studies and Q&A, the presenters underscored the necessity of detailed, narrative documentation that clearly outlines patient condition, medical decision-making, interventions, and exact timing. They encouraged ongoing provider education and practice-specific systems to capture critical care time accurately, avoid audits, and secure appropriate reimbursement. Resources and future KEGG sessions were offered for continued learning.

Keywords

Medicare Physician Fee Schedule 2026

Critical Care Billing

Anesthesiology Documentation

Accountable Care Organizations

Telehealth Coverage Changes

CMS Critical Care Definitions

CPT Coding Guidelines

Split/Shared Visit Modifiers

Physician Fee Reimbursement

Documentation Requirements

Telehealth Visit Frequency

Virtual Supervision Allowances

Office of Inspector General Audit

Split/Shared Visits Modifiers

Teaching Physician Documentation

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