decisionhealth Newsletters, Part B News - 2011 Issue 6 (June)
Ask a NPP Report Expert: Dealing with incident-to denials after an audit
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Article Overview
This Q&A explains a common audit issue involving incident-to billing for nonphysician practitioner services in a physician office setting. It is aimed at billers, coders, practice managers, and compliance staff who need to understand how auditors may evaluate routine follow-up visits, plan-of-care alignment, and the handling of newly raised concerns during an encounter. The article focuses on general billing and documentation considerations rather than on code selection.
Why This Topic Matters
Incident-to billing denials can affect reimbursement, compliance, and audit risk. Understanding the broad reasons auditors may question these claims helps practices review workflow, documentation, and supervision processes.
What You Will Learn
- How incident-to billing is evaluated in an audit context
- Why newly raised patient concerns can affect billing under a supervising physician
- How practices may respond when a nonphysician practitioner encounters an issue outside the established plan of care
- General considerations for documenting and billing office follow-up services
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance professionals
- Physician office staff
- Nonphysician practitioners
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