Practice Management Alert

Medicare is the only payer that consistently recognizes incident-to

If you don't know all of the situations when you should bill for services provided incident-to a physician, your office could miss out on justified reimbursement.

How? When a nonphysician practitioner (NPP) performs a service incident-to a physician, then the office can bill under the physician's Medicare number and secure 100 percent reimbursement.
 
If, however, the NPP's services are not provided incident-to the physician, you must bill under the NPP's number, which garners you 85 percent reimbursement for the same service.

When deciding whether a service can be billed incident-to a physician, you must ask yourself the following questions.

If you can answer -yes- to all of them, you should be able to report the service incident-to rather than under the NPP's Medicare number, thus raking in 15 percent more revenue for the service: - Is the physician present and available in the office? Medicare says the supervising physician must be -present and available in the office- when the NPP sees the patient in order to bill incident-to.

-Present and available in the office means that there is direct [physician] supervision, which means that the physician is physically present and readily available in the office suite,- says Chris Felthauser, CPC, CPC-H, ACS-OH, ACS-OR, PMCC, medical coding instructor for Orion Medical Services in Eugene, Ore.

So if the physician is in the next examining room at the facility, you can still bill for incident-to services. If he is off-site and only available by phone, however, bill under the NPP's number. - Is the patient following an established plan of care? If the physician has not established a plan of care, incident-to billing is impossible.

-The whole meaning of incident-to is that this is an established patient following a prescribed course of treatment by the physician and is presenting for follow-up in the office,- Felthauser says.

Consider this example: An NPP sees an established patient in the office to check on the patient's hypertension. The NPP performs a level-two evaluation and management service on the patient. The physician is in the office supervising but does not see the patient.

In this instance, -incident-to requirements were met; this is an established patient with an established problem and plan of care, and the physician is in the office. You may bill incident-to the physician using the physician's UPIN/PIN for the NPP's service,- says Jennifer Schmutz, CPC, health information coder with Neurosurgical Associates LLC in Salt Lake City.

On the claim, you should report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making) incident-to the physician.

Remember: Any services the NPP [...]