help with "Incident to" rules in billing


Scranton, PA
Best answers
Can someone please explain in basic terms -"INCIDENT TO" billing:confused: Medicare's guidelines are just a little too confusing to understand!!
First - is there a difference in billing for PA or CRNP in regards to incident to billing?!

Second - Is it incident to YES when the NP or PA is in the office seeing patient alone and the Dr is in the office ;and indicent to NO when the PA or NP is seeing the patient alone and the DR is not in the office.

Incident to means this visit is incident to the physician having already seen the patient for this exact same problem or episode of a recurrent problem. There must be a plan of care in the chart by the physician that states the patient is to return in follow up, and the provider must be in the office suite area while the patient in being seen. In short this is a follow up encounter, no new patient encounter or new problem visits may be incident to. Any time the provider is not on site it cannot be incident to. And any qualified physician employee may provide the service scheduled as long as it is in the area of expertise of the employee.