tci Medicare Compliance & Reimbursement - 2013 Issue 19
Incident-to Billing: Weigh the Pros and Cons Before Adding an NPP
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Article Overview
This article is aimed at medical practices considering whether to add a non-physician practitioner, such as a nurse practitioner or physician assistant. It explains the operational, financial, credentialing, payer, and billing topics that should be reviewed before onboarding, including the compliance attention surrounding incident-to billing. The discussion is useful for physicians, practice managers, billing staff, and coding/compliance professionals who want a broad planning view before expanding clinical staff.
Why This Topic Matters
Hiring an NPP can affect patient access, workflow, revenue, and billing compliance, so practices need to assess the operational and payer-side implications in advance. The article highlights why incident-to billing and related reimbursement processes are closely monitored and why early planning can help avoid denials and administrative rework.
What You Will Learn
- What factors to review before adding a non-physician practitioner to a medical practice
- How NPPs can affect workflow, patient access, and practice revenue
- Which operational and administrative areas need planning before onboarding
- Why scope-of-practice and payer policies matter for NPP services
- What to consider about credentialing, EMR setup, and billing workflows
- Why incident-to billing deserves special compliance attention
Who Should Read This
- Physicians
- Practice managers
- Billing staff
- Coding professionals
- Compliance staff
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