Aug 20th, 2025
Medicare Part B payments for “incident-to” services are once again under scrutiny by the HHS Office of Inspector General (OIG) who has flagged “incident-to” billing (when services by non-physician personnel are billed under a physician's NPI at full physician rate) as high risk for improper payments and program abuse. This is what they stated:
| Prior OIG work found that improving the transparency of incident-to services is critical to program integrity efforts. Our objective is to determine whether Medicare Part B payments for services performed incident to physicians' services complied with Medicare requirements. |
The results of this review are anticipated to be released sometime in 2026. Incident-to has often been the subject of audits and compliance concerns so their soon to be published findings may not necessarily be anything drastically different than what has been happening all along. Different experts have differing opinions and so it is essential that providers understand some of the commonly challenged areas:
- Improper supervision: Claiming full physician payment when an NP or clinical staff performed the work—without meeting the requirements for supervision or involvement. How available does the supervisor need to be? This is a hotly debated topic. According to an article on this topic by David M. Glaser, Esq., “At least through the end of 2024, a physician can supervise services incident to his or her work by being available through a smart phone or other device with both audio and visual communication.”
- New problem definition: There is quite a bit of debate about whether a non-physician provider (NPP) can bill services “incident to” if they address a problem that is not already part of a physician’s established plan of care. Many Medicare Administrative Contractors (MACs) have issued policies indicating that NPPs are unable to treat “new problems” under “incident to” rules. However, some attorneys are challenging those policies. Click here to read more about it.
Perhaps the OIG will address some of these ongoing issues. In the meantime, be sure you have firmly established policies and procedures included in your policies and procedures manual. Ensure that providers have clearly documented their presence, involvement, and plan-of-care in the patient's record. Perform your own internal audit to see if your organization is following the practice policies and procedures. If you have legal concerns, we encourage you to reach out to a qualified healthcare attorney for assistance.
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