decisionhealth Newsletters, Part B News - 2014 Issue 1 (January)
Sign of crackdown on incident-to services amended in fee schedule
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Article Overview
This article examines Medicare incident-to services in the context of the final 2014 Medicare physician fee schedule, with emphasis on state scope-of-practice requirements, auxiliary personnel qualifications, and potential audit scrutiny. It is relevant to physicians, practice managers, nonphysician practitioners, and billing/compliance staff who need to understand how Medicare policy and state licensure rules intersect. The article also references prior OIG work and an AANP state practice summary to frame the broader compliance environment.
Why This Topic Matters
Incident-to billing can create compliance risk when staffing, supervision, licensing, or scope-of-practice issues are not aligned with Medicare and state law. Understanding the policy landscape helps practices reduce exposure to audits and billing errors.
Article Sections
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Physician payments
Introduces the policy change in the final 2014 Medicare physician fee schedule and its possible implications for audit focus and compliance oversight.
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Assess who provides services at your practice
Discusses the need to review clinical roles, licensing, and state scope-of-practice alignment for services billed under Medicare incident-to arrangements.
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Scope of practice for services rendered by NPs
Summarizes a state-by-state perspective on nurse practitioner practice environments and includes a general overview of the AANP classification approach.
What You Will Learn
- How Medicare incident-to services are discussed in relation to the 2014 physician fee schedule
- Why state scope-of-practice rules are important to incident-to compliance
- What kinds of staffing and licensure issues may draw audit attention
- How prior OIG work has influenced concern about incident-to billing
- How state practice environments are categorized for nurse practitioners
Who Should Read This
- Physicians
- Practice managers
- Medical billers and coders
- Compliance staff
- Nurse practitioners
- Physician assistants
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