"Incident to" Billing

telemind

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`We are looking to adding two APRNs to our practice in NV and had a few questions about ''incident to'' billing for psychiatry visits.
We have our local biller advising us that we are able to bill under incident to while pending to become credentialed ?
But when we contact our insurances provider network they advise us that we are unable to bill under incident to/ supervising MD?

Please advise if anyone is familiar with this rule or can provide any clarification on it.
Thank you!
 
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Hi, different private payers have different rules.

Incident-to is a Medicare concept and some private payers don't allow it at all. Even when a private payer has an incident-to policy it may be very different from Medicare's. For example, Anthem specifically states incident-to is restricted to medical staff who are not eligible to submit claims to the plan, such as RNs and MAs.
https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_e245197.pdf?refer=ahpmedprovider&state=mo
https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_e245197.pdf?refer=ahpmedprovider&state=mo

C. The Health Plan does not follow CMS “Incident to” reimbursement rules for any physician or non-physician provider (NPP)who has been assigned or is waiting for his/her own NPI. Therefore: If a provider has an NPI and is recognized by the Health Plan as eligible to submit claims directly to the Health Plan, then the provider is required to report his/her services under his/her own NPI. Separately reportable “Incident to” services are only eligible for reimbursement under the supervising provider’s NPI if the specific type of NPP or qualified auxiliary office personnel who rendered the services is ineligible to submit claims directly to the Health Plan. This rule will apply even when a provider is in the process of applying for his/her own NPI. If the provider is a type who is eligible to receive an NPI and is recognized by the Health Plan to submit claims directly to the Health Plan, then while the provider is waiting to receive his/her NPI, his/her services are not eligible for reimbursement as “Incident to” services.
It's always worthwhile to check the payer's policies directly. Sometimes a representative may miss an update to policy.
 
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