Wiki Incident to billing

[kstill78]

My provider is wondering since we are currently in a pandemic does she have to be in the suite when our PA sees a patient, would a picture and text suffice as far as her being involved in the care? or did they only relax for telephone visits and not in person.

 

[SharonCollachi]

[Incident to] Criteria: Medicare pays for services ... The services are rendered under the direct supervision of the physician, CP, NP CNM, CNS, or in the case of a physician directed clinic, the Physician Assistant (PA).​

From Medicare: Physician Supervision Requirements during pandemic: For services requiring direct supervision by the physician or other practitioner, that physician supervision can be provided virtually using real-time audio/videotechnology.


I'm not sure what you mean by "picture and text", but it doesn't seem to meet the criteria.

 

[kstill78]

[Incident to] Criteria: Medicare pays for services ... The services are rendered under the direct supervision of the physician, CP, NP CNM, CNS, or in the case of a physician directed clinic, the Physician Assistant (PA).​

From Medicare: Physician Supervision Requirements during pandemic: For services requiring direct supervision by the physician or other practitioner, that physician supervision can be provided virtually using real-time audio/videotechnology.


I'm not sure what you mean by "picture and text", but it doesn't seem to meet the criteria.

thank you for the link. She was wondering if the PA could send a pic of the problem and she respond via text. I work for a dermatologists, that may make more sense. A new problem could be a rash for ex.

 

[thomas7331]

thank you for the link. She was wondering if the PA could send a pic of the problem and she respond via text. I work for a dermatologists, that may make more sense. A new problem could be a rash for ex.

Keep in mind too that a new problem can never be billed as 'incident to' - the physician must always have a face-to-face service with the patient and personally initiate the plan of care for any new problem. 'Incident to' billing can only occur when the PA is executing an existing plan of care. So if the PA is just showing the patient a picture of a new problem, then that alone does not satisfy the 'incident to' requirements - the physician needs to document their own note. If that hasn't taken place, then the PA needs to bill this encounter under their own credentials.

Medicare has relaxed the supervision requirements during the pandemic, so direct supervision does not necessarily require the physician be on site, but the other requirements of 'incident to' billing are still in place.

 

[kstill78]

Keep in mind too that a new problem can never be billed as 'incident to' - the physician must always have a face-to-face service with the patient and personally initiate the plan of care for any new problem. 'Incident to' billing can only occur when the PA is executing an existing plan of care. So if the PA is just showing the patient a picture of a new problem, then that alone does not satisfy the 'incident to' requirements - the physician needs to document their own note. If that hasn't taken place, then the PA needs to bill this encounter under their own credentials.

Medicare has relaxed the supervision requirements during the pandemic, so direct supervision does not necessarily require the physician be on site, but the other requirements of 'incident to' billing are still in place.

Thank you so much!