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Define "patient" for incident to billing


Local Chapter Officer
Best answers
There is a new discussion in my office regarding incident to guidelines. Some are saying that in the guidelines "patient" is referring to any patient that is established with a practice. Some are saying "patient" refers to any person walking through the door for medical care in your office/facility - whether they are one-time only (visiting from out of town) or been seen there for 20 years. I know the Medicare incident to guidelines, but am looking for something more specific that I can present to others about what constitutes a "patient" for incident to purposes.

Help please!
Thank you!


True Blue
Columbia, MO
Best answers
The reason it is called incident-to is because this current encounter is incident to a previous encounter for the same problem, with a physician in this office, and there is a plan of care for the ancillary personnel to follow. It cannot be a new patient or a new problem as that would not meet this criteria. In addition Nurses, and MAs are not licensed to evaluated a patient and determine a diagnosis and treatment. They are only allowed to follow providers orders set forth from previous encounters. Also for incident to the providers NPI is used in field 24J as the supervising/rendering provider, he cannot supervise care for a patient he has yet to evaluate.