Medicare Compliance & Reimbursement

Know the rules before you try to bill incident-to. Question: One of our non-physician practitioners (NPP) saw a patient during a follow-up visit -- what is required in order for us to report these services to Medicare as incident-to the NPP? Answer: To qualify for incident-to, the NPP must have seen the Medicare patient during a prior visit and established a clear plan of care. If the NPP is treating a new problem for the patient, or if the doctor has not established a care plan for the patient, then you cannot report the visit incident-to. Important: When meeting the requirements for established plan of care follow up, if the internist does not directly supervise the NPP, the incident-to rules do not apply. Direct supervision means a supervising physician must be immediately available in the office suite. The supervising physician, however, does not necessarily need to be the same physician that [...]