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Incident To Billing in Primary Care

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billerannie18

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Can anyone give specific examples on instances when incident to billing is and isn't allowed? The language on Medicare's website is not very specific. What are the charting requirements needed in order to bill incident to? Thank y ou!
 
Hi there, I also recommend checking your Medicare administrative contractor's guidance on incident-to services. They will have facts sheets and may have also FAQs and free webinars that explain incident-to.
 
in a nutshell- an APP can have their own caseload if the scope of practice allows in that state & the practice is ok with that. if they maintain their own caseloads incident to would never be an issue unless the MD becomes involved with the treatment plan. for incident to the MD must see the pt & set up the treatment plan. the APPs can then take over subsequent visits as long as they stick to the treatment plan. if they see somebody & change the treatment plan the MD must also be involved. for incident to visits the MD does not have to see that pt BUT must be ONSITE in the SAME clinic as the APP. they CANNOT be across the street at at hosp or ASC doing surgery or next door getting lunch! it can be any MD in the clinic that day not necessarily the MD who saw the pt to begin with.
 
Here is an example. The PA or NP sees a brand new patient and establishes care with them. The patient is brand new and has never seen anyone in the group, clinic or this provider before. They just moved to the city they are being seen in and this is their first visit. This cannot be incident-to.

Example: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00150920
From the link above:
Documentation
The patient’s medical records must clearly indicate the following:

Individual who rendered the service
Physician’s presence in the office at the time of the service
Physician’s initiation and continued involvement in treatment
Services within the scope of practice of the non-physician practitioner as defined by state law
Reasonable and necessary
The documentation submitted to support billing “incident to” services must clearly link the services of the NPP auxiliary staff to the services of the supervision physician. Evidence of the link may include:

Co-signature or legibly identify and credentials (i.e., MD, DO, NP, PA, etc.) of the both the practitioner who provided the service and the supervising physician on documentation entries.
Documentation from other dates of service, for example the initial visit establishing the link between the two providers.
Make sure the name and professional designation of the person rendering the service is legible in the documentation of each service.
 
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