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Gastroenterology Coding Alert

Incident-to Billing:

4 Criteria You Must Meet Before Filing an Incident-to Claim

Published on Tue Feb 14, 2012

Miss these items and you'll be in the OIG's hot seat.If you don't know how to correctly bill the services the non-physician practitioners (NPPs) in your office perform, it could cost you more than the 15 percent difference in reimbursement rates.Here's why: As part of its 2012 Work Plan, released on last October, the HHS Office of Inspector General (OIG) plans to scrutinize incident to services.Your best bet for avoiding OIG scrutiny is not to bill incident to unless you're sure you've met the requirements. Here's what you need to know to keep you practice off the OIG hot list.Learn What Incident to MeansAs most practices are aware, under incident-to rules, qualified NPPs can treat certain patients and still bill the visit under the physician's National Provider Identifier (NPI), bringing in 100 percent of the assigned fee.How it works: When an NPP provides a service to a Medicare patient incident-to [...]
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