6-Point Checklist for Incident-To Billing
It seems every few months Onpoint Medical Solutions is asked how to get reimbursed for incident-to billing. So, it seems like a good time to provide the six basic requirements.
Many practices utilize non-physician practitioners (NPPs) such as nurse practitioners and physician assistants. This is an effective way to increase productivity for the practice. Additionally, under Medicare rules, incident-to billing allows reimbursement at 100% of the physician’s fees versus 85% if the service was not billed incident-to. The following 6 steps detail what is necessary to meet the incident-to billing requirements.
The services must take place in a setting other than in a hospital or skilled nursing facility.
A physician who is credentialed with Medicare must initiate a patient’s care. Incident to services cannot be rendered on the patient’s first visit, or if a change to the plan of care is required. A change in the plan of care includes a medication adjustment.
After the first visit where a diagnosis and plan of care has been made then an NPP may provide the follow-up care.
A physician must actively participate in and manage the patient’s treatment. The definition of ‘actively participate’ is determined by the state licensure rules for physician supervision of NPPs.
The NPP and the credentialed physician must be employed by the same entity.
The incident-to service must be the type of service that is usual and customary to the practice and treatment.
For those who do not engage Onpoint to manage your billing and collections, please feel free to email us any questions or concerns that you may have about any issue related to billing and collections. We are more than happy to help.