Wiki Incident to billing/coding

[Nstettner88]

At my facility we are going to start billing "incident to" for a PA that is going to be working in our urgent care and possibly eventually move into our family practice. I have been researching the guidelines and brought them to my CEO. My question is: do the guidelines only apply to Medicare patients? Also can you only bill "incident to" for Medicare patients? Or does this apply to ALL payers regardless? My management stated that we can bill "incident to" for anyone, and the only time the guidelines need to be followed is when it's a Medicare patient.
Also is there any work that the supervising physician has to do when we are using that MD's NPI for billing?

Any clarification on this would be helpful as I am lost and do not feel what I am being told is necessarily true.


Thank you,
Nicole Stettner, CPC
Coding Analyst

 

[CodingKing]

Most payers follow Medicare rules or a variation of medicare rules. Some commercial payers do not allow incident to billing. You will want to look at each payers requirements. Incident to does not apply in facility setting. I don't see how urgent care could meet any payers incident to standards. Service must be under the supervising physician plan of care so it would not be typical an urgent care setting.

 

[elzabet72]

I agree, true incident to billing requires a plan of care to be in place. Your practice would be better off to credential the APP and bill under his own NPI.

 

[Nstettner88]

Thank you,
I agree with both of you and have been trying to explain this to my COO and Director of Operations, but have not been successful. I have reached out to our main payors here and they all are stating that they follow CMS guidelines, which to legitimately bill "Incident to" this PA will not be able to work in our UC. We are going to get this PA credentialed, but my clinic wants her to start right away and be able to bill out services and receive payment for them. I appreciate the help.
-Nikki