Wiki SA Modifier

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Hello, Was wondering if anyone is experiencing any issues billing the SA modifier? I have a new practice that is not currently billing the SA modifier for Incident to. I asked them why and they said it was not required since CMS does not accept the SA modifier. I provided the policy for BCBS and UHC to them. Am I missing something?


 
Hi,
You're right. If they're billing a private payer/plan that requires SA for incident-to, they must use it.
 
Does incident to billing apply to MD's that are non yet credentialed? If a new MD starts with a practice before the credentialing has been completed, can you bill their visits under the main MD at the practice?
 
LisaJ0867 said:
Does incident to billing apply to MD's that are non yet credentialed? If a new MD starts with a practice before the credentialing has been completed, can you bill their visits under the main MD at the practice?
Click to expand...

It does not apply unless all of the other requirements for are met (e.g. direct supervision, established patients and established problems only, no changes to care plans, etc.) MDs do not normally practice 'incident to' another MD - they are not trained or accustomed to working this way. Unless they are strictly adhering to the 'incident to' rules, billing one MD's services under another MD is incorrect and potentially fraudulent.
 
LisaJ0867 said:
Does incident to billing apply to MD's that are non yet credentialed? If a new MD starts with a practice before the credentialing has been completed, can you bill their visits under the main MD at the practice?
Click to expand...

This could cause more trouble for the new doctor and the practice in the long run. I can't find anything that specifically states you can't bill a doctor's work incident-to another doctor, but everything I did read refers to NPPs billing incident-to a physician. In addition, Medicare may view this as an attempt to get around its enrollment process. And it may not be necessary. You can retroactively bill for at least some of the new doctor's services during the enrollment process. Check the enrollment section on your MAC's website.

You'll need to check each private payer's policy starting with the credentialing application to see if it is allowed.

If you do go the incident-to route for Medicare make sure you report under a physician who is in the office suite and immediately available during the time the new doctor is seeing patients. If you automatically assign his/her work to the main doctor in the practice you may accidentally violate incident-to rules.

That was a great question, thanks!
 
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