decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Incident-To Billing / Incident-to for other practitioners
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Article Overview
This article covers incident-to billing concepts for services performed by non-physician practitioners and other practitioners in a physician-based setting. It discusses who may perform these services, the role of employee and contractor relationships, Medicare and HHS-OIG oversight, and broad compliance issues that affect how practices think about incident-to arrangements. It is aimed at coders, billing staff, compliance personnel, and practice managers who need a high-level understanding of this billing topic.
Why This Topic Matters
Incident-to billing can affect how services are reported, how payer rules apply, and how practices manage compliance risk. Understanding the general framework helps organizations review staffing arrangements and billing practices without relying on assumptions.
What You Will Learn
- The basic concept of incident-to billing in physician office settings
- How staffing relationships can affect incident-to arrangements
- Why Medicare oversight and compliance scrutiny matter for incident-to services
- General considerations around time-based evaluation and management billing in this context
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
- Physician office administrators
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