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Wiki Incident To billing

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MiMiLora

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Hello all!
Ok I have done Incident To billing for about 2 1\2 years. I am now at an IPA(we credential providers with insurance companies). When I was the Billing\Collections\Credentialing Mgr at my old office I credentialed all of my mid level providers with insurance companies so that we would not have to bill Incident To. It was brought to my attention that one of these mid levels was billed as Incident To under a provider even though the mid level has been contracted with this patients insurance for more than a year now. It is my full understanding that once they are contracted you do cannot bill Incident To. Can i get some of your thoughts on this please?

Thank you in advance!
Lora, CPC
 
MiMiLora said:
Hello all!
Ok I have done Incident To billing for about 2 1\2 years. I am now at an IPA(we credential providers with insurance companies). When I was the Billing\Collections\Credentialing Mgr at my old office I credentialed all of my mid level providers with insurance companies so that we would not have to bill Incident To. It was brought to my attention that one of these mid levels was billed as Incident To under a provider even though the mid level has been contracted with this patients insurance for more than a year now. It is my full understanding that once they are contracted you do cannot bill Incident To. Can i get some of your thoughts on this please?

Thank you in advance!
Lora, CPC
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I think that will depend on each individual payers guidelines. Our PA's and NP's all have Medicare numbers, but are still allowed to bill Incident-to if Medicare's guidelines are met. We, for the most part, do not bill Incident-to very often, so I'm probably not the best resource, but I've never read that you are not allowed to bill Incident-to once the NPP is contracted. :confused:
 
Also keep in mind that not all payers recognize mid-levels and those services would have to be billed under a supervising physician. Incident to rules don't apply here.
 
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