Incident-To in PBB

neecen

Networker
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34
Location
North Ridgeville, OH
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Good day everyone! Can anyone tell me if incident-to billing is permitted in a provider based billing office? I have read numerous articles on incident-to billing and numerous articles on provider based billing. In all of the articles I have read, none of them discuss the combination of the two and if they are allowed.

Thank you in advance on insight you can provide!
 

Pam Brooks

True Blue
Local Chapter Officer
NAB Member
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2,231
Location
South Berwick, ME
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Incident-to billing is an office billing concept. In a provider based clinic, you have to follow outpatient hospital rules.... the supervision rules are based on the CPT, there has to be a physician's treatment plan of care in place, and in some cases, an order or referral for services. CMS is murky about PBB, so the outpatient facility guidance in CMS and 42CFR needs to be followed.
 

neecen

Networker
Messages
34
Location
North Ridgeville, OH
Best answers
0
Incident-to billing is an office billing concept. In a provider based clinic, you have to follow outpatient hospital rules.... the supervision rules are based on the CPT, there has to be a physician's treatment plan of care in place, and in some cases, an order or referral for services. CMS is murky about PBB, so the outpatient facility guidance in CMS and 42CFR needs to be followed.
Thank you so much. This makes perfect sense to me however, I couldn't find any resources to show to my committee. I will definitely go in and print this rule.
 
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