Incident-To-Services

Are You Performing and Documenting Incident-To Services Correctly?

In performing hundreds of audits over the years, I’ve found that one issue that continues to cause a huge concern — and often large paybacks to Medicare — is the process of billing for incident-to services.

Put simply, this concept allows a nonphysician provider (NPP) — such as a nurse, medical assistant, lab technician or psychologist — to see a patient under the guidance of an MD or DO and continue his or her established treatment plan. If all services are performed correctly, the treatment may be billed to Medicare under the name of the physician who provided the supervision on the date of service.

The Centers for Medicare & Medicaid Services (CMS) has established a comprehensive set of rules that must be followed for services to be eligible for incident-to billing. They include:

• The services are an integral, although incidental, part of the physician's professional service.

• The services commonly are rendered without charge or included in the physician's bill.

• The services are of a type commonly furnished in physicians' offices or clinics.

• The services are furnished under the physician's direct personal supervision and are furnished by the physician or by an individual who is an employee or independent contractor of the physician. Direct supervision does not require the physician's presence in the same room, but he or she must be present in the same office suite and be immediately available.

• The physician must perform the initial service and subsequent services of a frequency that reflects his or her active participation in the management of the course of treatment.

• The physician or other provider under whose name and number the bill is submitted must be the individual present in the office suite when the service is provided.

Bear in mind, the term “incident to” was developed by CMS and is strictly related to services rendered to a patient who is covered by Medicare. These rules relate to CMS services only. Private payers may use a similar term, and it is the responsibility of the practice to know the rules associated with each individual private plan as it relates to the concept of nonphysician provider (NPP) services. A practice bills using the NPP Medicare provider number for services that the NPP performed, that falls outside the scope of this scenario.

Physicians should conduct periodic incident-to audits the ensure compliance with CMS incident-to rules. These audits are essential for maintaining regulatory compliance, accurate billing, and proper reimbursement.

We are currently offering a Summer Compliance Auditing special:

10 medical record review with a Summary of Findings report for $750.00 (physician office/clinic visit). Contact us for additional information.