Incident To

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Our software requires each provider that is put into our system to submit claims be credentialed with them and a $5000 fee must be paid. One of our docs will be on vacation for a week and a physician from another practice will be covering for him. Can we bill 'incident to' under another physician in the office?

Please advise
 

btadlock1

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Our software requires each provider that is put into our system to submit claims be credentialed with them and a $5000 fee must be paid. One of our docs will be on vacation for a week and a physician from another practice will be covering for him. Can we bill 'incident to' under another physician in the office?

Please advise
You're probably looking for locum tenens or reciprocal billing - the situation you're describing is not 'incident-to'. Check out this publication from Trailblazer - even if they're not your MAC, the info should be helpful:
http://www.trailblazerhealth.com/Publications/Training Manual/Locum Tenens.pdf
;)
 
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Similar Question

New provider, not yet credentialed. Can we bill under another provider until it goes through or is the only alternative to hold the claims until the process has been completed. The credentialing sometimes is taking longer than the alloted submission time frame. My initial thought is NO but our Sr Admin team insists that we can do this. As far as they are concerned, if there is no documentation that states it cannot be done, it can be done....

HELP!!!!!!!
 
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New provider, not yet credentialed. Can we bill under another provider until it goes through or is the only alternative to hold the claims until the process has been completed. The credentialing sometimes is taking longer than the alloted submission time frame. My initial thought is NO but our Sr Admin team insists that we can do this. As far as they are concerned, if there is no documentation that states it cannot be done, it can be done....

HELP!!!!!!!
 

margsablan

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"Incident to"

THE INCIDENT-TO RULES IN SHORT

Following is a summary of the incident-to rules that must be followed when billing Medicare for nonphysician providers' services performed incident-to a physician's service:

The nonphysician providers must be W-2 or leased employees of the physician, and the physician must be able to terminate the employee and direct how the Medicare services are provided by that employee.


The physician must perform the initial patient visit and ongoing services of a frequency that demonstrate active involvement of the physician in the patient's care, thereby creating a physician service to which the nonphysician providers' services relate.

A physician must be on the premises, but not necessarily in the room, when incident-to services are performed.

Diagnostic tests must be done under the testing supervision requirements: general, direct and personal, which are designated by CPT code.

Incident-to services cannot be performed in the hospital.

If these rules are followed word for word and the new provider (not credentialed) may fall under the category and they are not considered eligible professional. You can bill under the provider's (credentialed) "incident to" a physician care if the above requirements are followed.
 

mitchellde

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You can bill only NPPs incident a physician you can never bill a physician incident to another physician. If you have a new physician that is not yet credentialed , you can hold his claims until the credential is finished or you can bill his visits out of network as long as the patient is informed of this prior to the appointment.
 
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