Wiki Incident To Question

[LEE ANN]

Physician sees pt 2 years ago and establishes diagnosis and treatment plan. Pt has been seeing Nurse Practioner in office since that time for this problem. Is there any time limit on how long it has been since the patient has actually seen the physician for the condition in order to continue billing incident to?

 

[RebeccaWoodward*]

Physician sees pt 2 years ago and establishes diagnosis and treatment plan. Pt has been seeing Nurse Practioner in office since that time for this problem. Is there any time limit on how long it has been since the patient has actually seen the physician for the condition in order to continue billing incident to?

Excerpt from Medicare's "incident to" guidelines...

"There must have been a direct, personal, professional service furnished by the physician to initiate the course of treatment of which the service being performed by the nonphysician practitioner is an incidental part, and there must be subsequent services by the physician of a frequency that reflects the physician’s continuing active participation in and management of the course of treatment.

2 years is too long. I have known some practices to alternate the visits between the midlevel and the provider. I've seen others schedule the patient with the provider at every 3rd visit (assuming there haven't been any new issues). I recommend that your practice create a policy for the frequency that a provider needs to see patients under "incident to" guidelines.

 

[cheermom68]

incident to

I agree that 2 years is too long. Also, I would find it unusual that no change in treatment plan was undertaken in that amount of time.

 

[LEE ANN]

Thanks - I agree and I just needed some backing in black and white!

I agree that 2 years is too long. Also, I would find it unusual that no change in treatment plan was undertaken in that amount of time.

Excerpt from Medicare's "incident to" guidelines...

"There must have been a direct, personal, professional service furnished by the physician to initiate the course of treatment of which the service being performed by the nonphysician practitioner is an incidental part, and there must be subsequent services by the physician of a frequency that reflects the physician's continuing active participation in and management of the course of treatment.

2 years is too long. I have known some practices to alternate the visits between the midlevel and the provider. I've seen others schedule the patient with the provider at every 3rd visit (assuming there haven't been any new issues). I recommend that your practice create a policy for the frequency that a provider needs to see patients under "incident to" guidelines.