decisionhealth Newsletters, Part B News - 2015 Issue 3 (March)
Put extra guidance in care plan to give NPPs incident-to leeway
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Article Overview
This short Q&A article is aimed at medical coders, billers, and practice staff working with physician and NPP workflows in outpatient diabetes management. It explains a common incident-to billing question, highlights the importance of the physician’s plan of care, and discusses how care-plan wording can affect whether an encounter is billed under the physician or the NPP.
Why This Topic Matters
Incident-to billing is a frequent compliance and reimbursement issue in practices that use mid-level practitioners. Understanding how the plan of care is documented can help teams support accurate claim submission and avoid billing errors.
What You Will Learn
- How incident-to billing is raised in a diabetes follow-up scenario involving an NPP
- Why the physician’s plan of care matters in determining the billing pathway
- How care-plan language may influence whether services are treated as incident-to or billed under the NPP identifier
- What type of documentation emphasis is discussed for supporting NPP follow-up care
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
- Physicians
- Nurse practitioners
- Physician assistants
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