Are incident to services worth the risk

by 
August 13th, 2018

Incident-to services allow non-physician practitioners (NPPs) such as nurse practitioners and physician assistants to bill under a supervising physician if they perform services that are incidental to a physician-created plan of care.

Incident-to billing offers two key benefits: First, the physician is reimbursed at 100% of the contracted rate with the payer, while NPPs typically are reimbursed at 80% or 85% of the contracted rate, so if an NPP can bill under the physician, the reimbursement is higher. Second, billing under the physician allows a non-credentialed NPP to see patients, barring any payer-specific rules that may require the NPP to be credentialed.

However, there are also two significant disadvantages to incident-to billing. First and foremost, the rules are difficult to follow and potentially disruptive to clinical workflow, as we will explore later in this tip; if the rules are not followed carefully, incident-to can be a major compliance risk. Second, the various commercial payers have different rules on incident-to services, and these may not be easily available for review.

Incident-to requirements

Let’s start by going over the incident-to rules below.

Top incident-to questions

Now that we have reviewed the requirements for incident-to services, let’s look at some of the most common questions that arise when dealing with incident-to.

Conclusion: Is incident-to worth the compliance risk?

There’s no question that incident-to services can offer flexibility and increased reimbursement when using NPPs in the outpatient setting. However, if you decide to bill under incident-to guidelines, you are electing to comply with a complex set of rules that vary by payer, and you must assume full responsibility for learning and following each payer’s rules.

References:

Are incident to services worth the risk. (2018, August 13). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/are-incident-to-services-worth-the-risk-34295.html

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