Wiki Mid-level Is Changing to Incident To Billing on Secondary Claims


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The practice has an NP who bills under her own credentials for Medicare services, then changes the billing on the claim to Incident To for the secondary submission to Medicaid because they do not allow mid-levels to bill under their own credentials - is that even legal???
No it is not. You are misrepresenting the service to the secondary to get paid for something they indicated (by not credentialing) they would not pay for. If the secondary indicated to bill services using the MD NPI, the OIG states to get this in writing as a policy from this payer, where they payer clearly indicates they recognize that the MD may have not examined the patient for this same dx and the MD may not be in the office at the time of the encounter. Chances are extremely good you will not be able to capture this in writing since most if not all payers follow Medicare on this.