Wiki when does "incident to" end?

[jgeorge]

Say a patient is seen initially by PA. Then, on a subsequent visit for the same injury/illness the patient is seen by an MD.

After that MD encounter, can we bill ?incident to? for subsequent PA visits for the same injury/illness?

 

[gkaufman]

The incident-to rules have not changed, but what is always a variable is the interpretation of the rules. Incident-to services require active involvement by both the non-physician provider (NPP) and the supervising physician (SP). If both did NOT have the active role that is set forth by CMS, the incident-to service would not have been met.
Some guidelines:
- The SP must on-site and must establish a plan of care for all new patients and established patients presenting with new problems.

- The SP must remain in an ?active? role in the patient?s ongoing care. While CMS National Guidance does not adequately define the active role, some local carriers more clearly define this. It is a benchmark that active involvement would include the SP seeing the patient every 3rd visit.

- CMS rules do NOT require the SP to sign-off on all of the NPP?s charts billed incident-to even though in many instances their involvement is required.
Check with your local Medicare carrier for specific guidelines.