Wiki Incident To Billing

[holbjm@hotmail.com]

My physician and I are in disagreement on the understanding on incident to billing for MLP. If a new patient is seen or an established patient is seen and has a new issue the physician must see the patient and bill or if the MLP bills it will pay at 85% rather than the 100% physician due to the incident to guidelines. Is this correct?

Also, is there a new guideline with CMS Medicare that the MLP NPI must be on the claim in addition to the provider NPI?

 

[Pam Warren]

You are correct. You may not bill incident-to if you have a new patient or a new problem. The midlevel can see the new patient/problem, but you would bill under the midlevel and obtain 85% of the Medicare allowable. For supporting guidance, look at the Medicare IOM 100-02 Chapter 15, section 60 or 100-04 Chapter 12, Section 30.6. Your MAC may have additional guidance.