Everything You Want To Know About “Incident To Billing”

1
Everything You Want To Know About Incident To
Billing
MGMA has reported that many physician-owned
multi-specialty practices and groups often use
non-physician providers (NPPs). According to the
report, the reason is that the NPPs with the
practices often generate higher income than
physicians and are financially more viable.
NPPs, however, need to function directly under
the supervision of a physician to provide
billable medical services. Therefore, registered
nurse aestheticians, surgeons, or physicians'
assistants can be included in the facility under
the NPPs. Further under the Medicare fee
schedule, the NPPs' medical practices can receive
full payment and reimburse the amount for the
services successfully by reporting the NPSS
services under 'incident-to' for physician care.
But CMS has implemented strict and complex
guidelines for incident-to billing. Thats why
physicians must understand the rules of the
medical billing procedures correctly to receive
full payment from the insurers for the services
rendered by NPPs. Read moregtgt
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
2
Everything You Want To Know About Incident To
Billing
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
3
Everything You Want To Know About Incident To
Billing

• Hence, most centres that offer NPPs prefer to
  work with medical billing services to overcome
  the challenges of incident-to billing.
• What Should Physicians Know About Incident-To
  Billing?
• Here are some key points that a physician needs
  to know about incident-to billing for an office
  visit.
• There is quite a bit of ambiguity in the term
  'supervising physician.' The CMS states that a
  medical billing or supervising physician does not
  necessarily have to be the original physician or
  ordering physician on the patient's case.
• It is possible that the rules for incident-to
  billing a credentialed physician must make the
  diagnosis of the patient and set up a care plan.
  After this, the NPP can conduct a follow-up visit
  that can be billed to the incident-to, which
  complies with a detailed and defined plan.
• Furthermore, a supervising physician can have the
  same rules, but it is not mandatory.
• In the care of a patient, the provider under
  whose name the service is performed must be
  involved in the medical billing.

HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
4
Everything You Want To Know About Incident To
Billing

• The nurse practitioner cannot bill into
  incident-to when performing a service. Medicare
  specifies that time refers to the time spent with
  the physician. Hence, coordination care or
  counselling that is more than 50 of the
  physician's time is the key criterion in
  selecting the EM level of service.
• For services offered as part of partial
  hospitalization and hospital, outpatients can be
  billed to incident-to services under the CMS
  rules.
• How Are Incident-To Services Coded?
• Additional modifiers are not required when coding
  for incident-to-services. Instead, the standard
  CPT, HCPCS, and ICD codes can be used.
• When the coding is correct, Medicare reimburses
  for the services provided under incident-to by
  the NPPs for the total fee schedule amount.
  However, the submitting rules for incident-to
  billing differ for commercial payers from
  Medicare.

HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
5
Everything You Want To Know About Incident To
Billing
How To Be Incident-To Billing Complaint? The
failure to have proper incident-to-billing
compliance can mean a massive amount of
settlements being paid for the failure to comply
with the rules. For instance, in February of
2020, a family physician in Ohio had to pay
285,000 to settle the allegation of failure to
supervise nurse practitioner services billed at a
higher physician rate. There have been so many
fraudulent, wasteful and abusive incidents-to
billing practices that raise the cost of
healthcare in the US. Hence, the OIG and DOJ
spend quite a lot of their resources and time
investigating false claims based on their audit
or a complaint by a whistle-blower. Undoubtedly,
training your staff and staying on top of the
changing regulations can be a challenge. But
simultaneously, when you partner with an expert
medical billing and coding company that
specializes in incident-to billing such as 24/7
Medical Billing Services, you will soon
experience the benefit of having NPPs service.
Also, you can enjoy the benefit of having an
efficient revenue management cycle in place for
better ROI while increasing the scalability of
your facility by outsourcing medical billing and
coding.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
6
About Us
We are a medical billing company that offers
24/7 Medical Billing Services and support
physicians, hospitals, medical institutions and
group practices with our end to end medical
billing solutions. We help you earn more revenue
with our quick and affordable services. Our
customized Revenue Cycle Management (RCM)
solutions allow physicians to attract additional
revenue and reduce administrative burden or
losses.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
7
Contact Us
Media Contact 24/7 Medical Billing
Services Georgia 3001 Greenfield Drive, Marietta
GA Ohio 28405 Osborn Road, Cleveland, OH
4414030068 Texas 2028 E Ben White Blvd,
240-1030 Austin TX, 78741 Delaware 16192
Coastal Highway, Lewes, Delaware 19958, United
States Phone no / Fax [phone]
Email us info_at_247medicalbillin
gservices.com
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/