Incident to Billing Clarification

Q:  Incident to Billing – “I would like clarification of incident to billing… thanks.”

Chandra: A:  This would be a whole separate webinar, I’m sorry. The highlights, in my opinion, incident to billing we’re talking about someone else billing under the physician’s NPI (National Provider Identifier) and the rules around this are very stringent. There’s a lot of things the physician has to be in the office suite immediately available to intervene if there’s a problem, the nurse can only – and I say nurse because usually this is a nurse practitioner, or a physician assistant who is providing services incident to.

They have to be carrying out an already established treatment plan and it has to be a condition that the physician has already treated and established a treatment plan for. If the nurse practitioner deviates in any way from that already established plan, or treats a new problem, incident to billing goes out the window, you can’t use it. They went above and beyond just following the physician’s orders basically. JoAnne, you want to chime in?

Incident to Billing Clarification – Video

Chandra: A:  This would be a whole separate webinar, I’m sorry. The highlights, in my opinion, incident to billing we’re talking about someone else billing under the physician’s NPI (National Provider Identifier) and the rules around this are very stringent. There’s a lot of things the physician has to be in the office suite immediately available to intervene if there’s a problem, the nurse can only – and I say nurse because usually this is a nurse practitioner, or a physician assistant who is providing services incident to.

They have to be carrying out an already established treatment plan and it has to be a condition that the physician has already treated and established a treatment plan for. If the nurse practitioner deviates in any way from that already established plan, or treats a new problem, incident to billing goes out the window, you can’t use it. They went above and beyond just following the physician’s orders basically. JoAnne, you want to chime in?

JoAnne: I know that a lot of times physicians that are in the process of getting credentials with their own provider ID numbers ask if they can bill under another physician’s ID numbers within the group, absolutely not. When you bill incident to under the physician’s MPI number as a nurse practitioner, for example, and from a reimbursement perspective the practice will get reimbursed 100% of the allowed, opposed to if the nurse practitioner had her own numbers and billed under her own number she would get 85% of what is allowed.

A lot of times the physicians lean towards billing incident to but they do have to be within shouting distance, not a phone call even if the doctor’s next door, a surgical room or something, they have to be within shouting distance. The rules are very strict you have to be sure that you follow all those guidelines.

Alicia: And documentation, very, very clear.

JoAnne: Oh yeah, absolutely.

JoAnne: I know that a lot of times physicians that are in the process of getting credentials with their own provider ID numbers ask if they can bill under another physician’s ID numbers within the group, absolutely not. When you bill incident to under the physician’s MPI number as a nurse practitioner, for example, and from a reimbursement perspective the practice will get reimbursed 100% of the allowed, opposed to if the nurse practitioner had her own numbers and billed under her own number she would get 85% of what is allowed.

A lot of times the physicians lean towards billing incident to but they do have to be within shouting distance, not a phone call even if the doctor’s next door, a surgical room or something, they have to be within shouting distance. The rules are very strict you have to be sure that you follow all those guidelines.

Alicia: And documentation, very, very clear.

JoAnne: Oh yeah, absolutely.

Related Incident to Billing Clarification Posts:

Incident to Billing Clarification | Medical Billing Guidelines

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2016-11-20T23:36:46+00:00

About the Author:

JoAnne Sheehan
JoAnne Sheehan has been successfully providing medical billing, coding and practice management services in the New England area for over thirty-three years. She has witnessed the evolution of healthcare and the increased complexities of medical billing and coding regulations, creating a need for education in this field. JoAnne has been featured in numerous medical publications and has acted as a medical billing expert in highly profiled Medicare and Medicaid fraud cases in Boston and has trained others on both a local and national level in medical billing and coding. She is a certified medical coding instructor, practice management consultant, and an AAPC approved ICD-10-CM instructor. Her hands-on experience is an asset for the CCO students she coaches. She is President and Founder of Lomar Associates, Inc., a practice management company established in 1981.

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