Incident to billing

shanamarie

Contributor
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Eagan
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If a patient is seen for a current problem that is worsening, and the PA orders a test for that worsening condition, can this be billed as incident to? Or since a test is ordered would this automatically be considered non incident to? Thanks for any guidance!
 

Pathos

True Blue
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614
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Beaverton OR
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If the physician has already seen the patient for the current (not new) problem, then the PA can bill "Incident to". Otherwise, you would need to bill with the PA's NPI instead.

All that said, "Incident to" rules are usually payer-specific, but the rule I mentioned above is from CMS which is often followed by most commercial payers. I would double check with the payer policy on "Incident to" before assigning NPI to the claimm

Here is a good reference:

https://med.noridianmedicare.com/web/jfb/topics/incident-to-services

Hope this is helpful!
 
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So if a PA sees a patient for a established problem that is worsening and orders an xray that wasn't under the established plan by the Dr, the visit can be billed under the Dr?
 

Pathos

True Blue
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614
Location
Beaverton OR
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If the patient is a Medicare patient (Original Medicare or Part C), then I would say no due to worsening problem (see Incident to rules). However, if the patient has a commercial insurance, their policies might be different. I would double check with your Provider Rep and find out what their policy is around Incident to.
 
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I have an inpatient that was see by the PA on 11/5. The physician went and seen the patient on 11/6 and the note starts like this: The patient is a 77 year old gentleman seen along with Sarah XXXX, PA from XXX on 11/5/19. I agree with the above listed history, physical examination and plan. Briefly he is.. and the note goes on the a few paragraphs and he does his own exam. The physicians have told me that if they see an inpatient they have 24 hours to dictate a note to be billed under their name. Is this true for share/split billing in hospital?
 
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