Question Incident to billing

SueLis

Contributor
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We bill incident to billing for our NP & PA for new pt's and new pt preventive visits to all insurances to all insurances except Medicare. When billing a NP or PA new pt visit/preventive as incident to for other carriers than Medicare don't the CMS incident to guidelines apply to that carrier also?
 

Orthocoderpgu

True Blue
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1,287
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Salt Lake City, UT
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Sue, I totally agree with Sharon. "Incident to" means that the patient has been seen the physician and has developed a treatment plan for that patient, and that the NP or PA is following that treatment plan as set forth by the physician. Generally speaking the NP or PA should be "working in the shadow" of the physician.
 

csperoni

True Blue
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Selden
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Here's another person full of opinions & agrees with other posters. For commercial carriers, they can set whatever rules they want about whether the PA/NP may be billed under the MD.
I will say years ago (many years ago), the commercial carriers would not even credential NPPs. Their advice was basically to always bill under the supervising MD. Then, they realized they could save money if they credentialed the NPPs and paid NPPs at a lesser rate. Currently, most of them seem to follow the CMS incident to guidelines from what I have seen.
 
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