Wiki Medicare Advantage Plans and Incident-To Billing

[toria11]

It's always been my understanding that Medicare advantage plans follow Medicare guidelines and therefore accept incident-to billing-- I'm unable to find specific policy information on this for each major carrier (except UHC). Thoughts? Is this what you believe to be true too? Thanks.

 

[thomas7331]

Yes, it's my understanding also that Medicare Advantage plans would follow these rules. Services performed 'incident to' a physician's plan of care are given coverage to all Medicare beneficiaries under the law so would have to be offered the same coverage under the managed Medicare plans. Advantage plans may add additional coverage for items not covered under regular Medicare but may not exclude from coverage services that Medicare is required to cover by law.

This is a bit of a legal/technical question, though, so my suggestion would be to confirm this with your organization's compliance officer or manager just to cover you in case there's ever a question about it.

 

[toria11]

Yes, it's my understanding also that Medicare Advantage plans would follow these rules. Services performed 'incident to' a physician's plan of care are given coverage to all Medicare beneficiaries under the law so would have to be offered the same coverage under the managed Medicare plans. Advantage plans may add additional coverage for items not covered under regular Medicare but may not exclude from coverage services that Medicare is required to cover by law.

This is a bit of a legal/technical question, though, so my suggestion would be to confirm this with your organization's compliance officer or manager just to cover you in case there's ever a question about it.

Thank you very much!