decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 2 (February)
Follow incident-to rules for 100% pay
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Article Overview
This article explains the Medicare incident-to framework that practices may use when billing nonphysician practitioner services in an office setting. It is aimed at urology practices and other provider organizations that want a clearer picture of when incident-to billing may apply, what kinds of supervision and documentation are involved, and which care settings are outside the scope of the discussion. The article also covers shared visits, physician involvement for new patients or new problems, and how employment relationships can affect billing decisions.
Why This Topic Matters
Incident-to billing can affect how a practice is paid and whether claims are submitted under a physician or a nonphysician practitioner. Understanding the article helps billing staff and clinicians recognize the general compliance issues that matter before claims are sent to Medicare carriers.
Article Sections
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Billing decision for nonphysician practitioner services
Introduces the payment choice between billing under the nonphysician practitioner or under incident-to arrangements. The discussion frames the article’s focus on Medicare claim submission in physician practices.
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Incident-to requirements and supervision expectations
Reviews the general Medicare requirements discussed for incident-to billing, including physician involvement, supervision, and the practice setting. It also touches on how these rules relate to new patients and established patients with new problems.
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Hospital and shared visit considerations
Addresses care delivered in hospital-related settings and describes the article’s discussion of shared visits. The section focuses on where the article says incident-to does or does not fit within the broader billing context.
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On-site supervision and employment relationship
Covers the article’s discussion of physician proximity, direct supervision, and the relationship between the supervising physician and the nonphysician practitioner. It also notes the employment arrangement issues raised in the article.
What You Will Learn
- How the article frames the payment options for nonphysician practitioner services
- Which general supervision and setting issues the article says practices should review
- Why shared visits and physician documentation are part of the discussion
- What employment relationship questions can affect incident-to billing considerations
Who Should Read This
- Urology practices
- Medical billing staff
- Practice managers
- Physicians
- Nonphysician practitioners
- Medicare reimbursement personnel
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