HHHHHEEELLLPPPPP INCIDENT TO BILLING FOR PHYSICAL THERAPY

[dosobill]

Can a physical therapist who isn’t credentialed bill under a credentialed physical therapist as incident to? I started a new job and the practice is wanting to bill like this and I am uncertain about it. I just need some advice.

 

[jkyles]

Hi, this question comes up from time to time and while Medicare doesn't expressly forbid doing this, it isn't necessary and can create compliance problems for the entire practice. You can retroactively bill for the new provider's services performed up to 30 days before they submit a complete enrollment.

One potential problem with the incident-to route is that you have to be very careful about following all of the requirements for incident-to, even though the performing and supervising practitioners are equal in training and credentials. So no new visits, there must always be a supervising provider available. Also keep in mind that the enrollment process is a major part of Medicare's fraud prevention effort. It's how CMS controls who receives Medicare funds, even in the form of provider salaries. Reporting the work of a provider who can bill Medicare directly under the NPI of another provider might look like an attempt to get around the enrollment process and that could impact the practice's ability to bill Medicare.

Sorry there's no definite yes or no answer here.