Incident-to: If a new patient, go direct bill route instead

Why This Topic Matters

Correct incident-to billing affects reimbursement levels and compliance risk for practices that use physician assistants or other nonphysician practitioners. Understanding the broad rules helps practices avoid billing errors that could lead to repayment demands, penalties, or audit scrutiny.

Article Sections

1. Incident-to billing for new patient visits

   Introduces the article’s focus on how incident-to billing applies when a nonphysician practitioner sees a patient who is new to the practice. Discusses the general distinction between incident-to billing and direct billing in that context.

2. Reimbursement differences and compliance concerns

   Explains that the same service may be billed through different pathways with different payment results. Highlights the broader compliance risk associated with using the wrong billing route.

3. Common incident-to billing pitfalls

   Reviews several broad scenarios that can create billing problems, including setting, supervision, and employment relationship issues. The section also notes increased oversight from a federal compliance agency.

4. Hospital setting and shared visits note

   Includes a brief note about related hospital-based billing questions and references additional guidance on shared visit situations. This section serves as a caution that the article’s main topic is limited to incident-to billing in other settings.