Wiki Incident to (auxilliary personnel)


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Has anyone had any experience with a physician practice hiring a new provider (waiting for credentialing) and billing the new providers services as incident-to? I have read the regulations over and over, but it does not specifically state that a "physician" is considered auxilliary personnel. I have also contacted Medicare and cannot get a clear cut answer. I have had this discussion with a "live person" three times now. Medicare directs me to read the regulations again....

I say that a physician does not qualify as auxilliary personnel and must hold claims until credentialled and then bill retroactively.


You are absolutely correct. A physician is NOT considered an ancilliary provider. However, you will not find this in the guidelines.

I have consulted off record on this in the past with a former Highmark Medicare Services employee who is very well known to providers throughout NJ, PA, CT, DE. Also, you may not use the Locum Tenens status to bypass the credentialing period either. Unfortunately, for payers in which a provider must be contracted, you will have to wait for that golden status of "credentialed" before submitting claims. Commercial carriers do not retro either so watch your dates of service when you release claims.

CMS is the gold standard for for most billing, coding, documentation regs and most commercial carriers adopt CMS policies in some fashion. Not everything we do is written down somewhere. You can email your local MAC with this question if you need a written response.

From a risk asessment perspective, the billing practice you inquired about is completely out of compliance. By the way incident to services are on 2012's OIG workplan. There will be increased scrutiny of these claims and their documentation.

Sometimes, the juice is not worth the squeeze.

Good Luck!
You'll need to hold the claims...

• Knowing misuse of provider identification numbers, which results in improper billing; 16

16= An example of this is when the practice bills for a service performed by Dr. B, who has not yet been issued a Medicare provider number, using Dr. A's Medicare provider number. Physician practices need to bill using the correct Medicare provider number, even if that means delaying billing until the physician receives his/her provider number.

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Not incident too

I am studying about to take my CPMA exam. It is clearly stated in the national guidelines that are for the medical auditors that billing physicians "incident too" prior to credentialing is considering fraud by the OIG.