Wiki incident to billing - Does Amerihealth credential midlevel providers

[kellyal]

Hello,

Does Amerihealth credential midlevel providers? Also can you bill incident to services to Amerihealth as long as you meet Medicare requirements for incident to?

thanks

Kelly Alexander

 

[sybutler]

Incident to Billing-Amerihealth

Kelly,

The best thing to do is contact Amerihealth directly and request written documentation if they credential mid-level providers and their requirements regarding incident to billing.

Sue Butler, CPC, CIMC

 

[tdove]

Incident to for Medicare

Does anyone know what the timeline is for Medicare to bill incident to services? For example pt is seen five years ago for stones and then pt comes back for stones do you think this would be incident to? My thought is a new patient is three years and I am not sure you can say PA is following the treatment plan when it was given over 5 years ago. Others in my office believe if pt was seen for stones then it is always incident to when pt sees Physician Assistant. I printed the 60-60.3 on Medicare processing manual but it is not clear enough and can be interpreted many different ways especially what is peoples interpretation of "integral part of physician service". Thanks for any thoughts

 

[erjones147]

I agree with your thoughts. If a patient hasn't been seen in 3 years and loses his/her established status, then how can the PA base services off of a exam that technically hasn't happened? No way to provide incident to services to a "new" patient, imho.

But I also would like to see any printed CMS guidance on this topic