General Surgery Coding Alert - 2011 Issue 22
Part B Revenue Booster: Don't Get Stuck Paying A 15-Percent Penalty If You Know You've Met Incident to Regs
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Article Overview
This article covers Medicare Part B incident-to billing for services provided by nonphysician practitioners and explains the main compliance areas practices need to review. It focuses on the relationship between the established plan of care, physician supervision, and practitioner qualifications, and it includes an example of how an established-patient visit may be reported. It is aimed at coders, billers, and practice staff who handle outpatient professional services and want to avoid billing errors tied to incident-to rules.
Why This Topic Matters
Incident-to billing can affect how outpatient professional services are reported and how a practice is reimbursed. Understanding the scope of the rules helps reduce claim errors, support proper supervision documentation, and avoid underpayment or other billing risk.
Article Sections
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How it works
Introduces the general concept of incident-to billing under Medicare Part B and explains the overall reporting context for services furnished by nonphysician practitioners.
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Ensure NPP Follows Provider's Action Plan
Discusses the role of an established plan of care and the follow-up relationship between the physician and the nonphysician practitioner.
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Verify Physician Supervision During Encounter
Covers the supervision component of incident-to billing and includes a brief illustrative encounter tied to outpatient evaluation and management reporting.
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Be Sure NPPs Meet Incident-to Credentials
Reviews the types of nonphysician practitioners referenced in the article and the general credentialing context for incident-to services.
What You Will Learn
- How incident-to billing fits into Medicare Part B outpatient services
- What broad conditions must be in place before a service may be reported under a physician’s NPI
- Why physician supervision and an established plan of care matter
- Which categories of nonphysician practitioners are discussed in relation to incident-to services
- How the article frames a sample office visit in the incident-to context
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Physician office staff
- Compliance staff
- Nonphysician practitioners
Codes Discussed
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