ED Coding & Reimbursement Alert - 2014 Issue 10
Compliance: Don't Fall Victim To Heightened OIG Scrutiny
Subscribe or sign in to view the full article.
Article Overview
This compliance article focuses on billing and documentation issues tied to non-physician practitioner services, with emphasis on Medicare incident-to requirements and the broader audit environment. It is intended for physicians, practice administrators, coders, billers, and compliance staff who need to understand how supervision, care-plan requirements, state law, and place of service can affect claim handling. The discussion also addresses how private payer policies may track Medicare concepts and why improper setup can lead to denials or scrutiny.
Why This Topic Matters
Understanding incident-to compliance helps practices reduce claim denials, avoid audit risk, and choose the appropriate billing pathway when services are furnished by non-physician staff.
Article Sections
-
Capture an Extra 15 Percent
Introduces the article’s main compliance topic and discusses incident-to billing in the context of non-physician practitioner services and practice revenue considerations.
-
Determine Encounter Place of Service
Reviews place-of-service considerations and the settings discussed in relation to incident-to billing eligibility.
-
Check Your State’s Scope of Practice Rules
Explains the role of state law and licensure requirements in evaluating whether incident-to services are appropriately furnished.
-
Save New Problems for the Physician
Covers care-plan and patient-visit prerequisites discussed for incident-to billing and what happens when those conditions are not met.
-
Differentiate Supervision Types
Addresses supervision concepts, office-suite presence, and related billing attribution considerations for services performed by non-physician staff.
What You Will Learn
- How incident-to billing is framed in physician practices
- Which compliance factors affect whether a service can be billed under a physician’s number
- Why state scope-of-practice and licensure requirements matter
- How supervision and place of service influence claim submission
- What general alternatives may apply when incident-to criteria are not satisfied
Who Should Read This
- Physicians
- Practice managers
- Medical coders
- Medical billers
- Compliance officers
- Non-physician practitioners
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com