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Thread: Incident to billing

  1. #1
    Join Date
    Apr 2007
    Grand Rapids

    Default Incident to billing

    AAPC: Back to School
    I have seen other posts regarding incident to billing but I was unable to go back and find them. I am wondering how other offices handle this - we have several NP/PA that see patients in the office and nursing homes - does anyone have a clear understanding of the incident to criteria and when to bill under the NP/PA or the physician? I have gone to our local Medicare site and printed their info regarding this. I am reading through it now to get a better understanding but it is so WORDY and not exactly clear. I was hoping someone else might have a clear understanding of what Medicare wants in this situation. Thanks for any help!
    Leandra Tufts, CPC, CEMC, COBGC

  2. #2
    Join Date
    Apr 2007
    Grand Rapids, MI


    If you have your midlevels credentialed with Medicare then you would bill directly under them, not the doc.

  3. #3


    You do not always bill under the PA's name, you can bill under the dr's name for incident to in some circumstances. Basically in order to bill for incident to for office visits the physician has to have seen the patient first and established a plan of care. If the patient follows up with the PA for the same problem you can bill under the dr's name but the dr has to be in the same office in case the PA needs to ask questions. If the patient follows up again but comes back for a different problem, the physician again has to see the patient for the different problem and establish a plan of care for the different problem before you can bill incident to again. For commercial plans you have to check with each individual carrier as they all have different rules. PA's have to be credentialed under Medicare, if they are not credentialed you can not bill, Each individual carrier has different credentialing guidelines, some want them completely credentialed, some do not. Some follow Medicare guidelines for billing, some commercial carriers always want you to bill under the dr.

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