Illinois and incident-to billing (non-Medicare)

Coder2468

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I'm hoping some Illinois people can answer a few questions for me.

Our practice has recently acquired a Nurse Practitioner. This is the first time we have had one, and the first time I've ever done billing for anything other than an MD. I have a pretty good grasp of Medicare's incident-to guidelines. The area I'm having trouble is with payers other than Medicare. Do any others follow incident-to guidelines? The only payer I've gotten a straight answer from is BCBS of IL. Our provider advocate gave me a firm "no", BCBS of IL does not follow that. I have contacted all our other big payers (UHC, Humana, Aetna, Cigna) and NONE can give me a straight answer. I get "We follow CMS guidelines" but then when I ask specifically about incident-to, I get "What's incident-to?". Or I'm told to refer to their policies online, which has been no help.

Any guidance on this would be greatly appreciated!

Stephanie Nolte, CUC
 
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