When to bill NPP services 'incident-to' for an additional 15%

Why This Topic Matters

Billing method can affect reimbursement, compliance, and audit exposure for practices that use nurse practitioners and other qualified non-physician providers. The article is relevant for ObGyn offices that want to understand the general requirements surrounding physician supervision and payer-specific billing policies.

Article Sections

1. Medicare’s pay rules

   This section introduces the Medicare payment distinction between billing in the practitioner’s own name and billing under the physician’s name. It frames the discussion around incident-to reimbursement and overall practice payment impact.

2. The dollars add up

   This section discusses the financial impact of billing decisions for common ObGyn services. It focuses on how small reimbursement differences can accumulate over time for practices with recurring NPP visits.

3. NPP services and third-party payers

   This section reviews how payer policies may differ from Medicare and why practices should confirm supervision requirements. It also highlights documentation and contracting considerations related to NPP services.

4. Medicare’s 6 top incident-to guidelines

   This section summarizes major Medicare incident-to supervision and billing topics for NPP services. It outlines the general situations in which the guidance applies and the practice settings where it does not.