tci Medicare Compliance & Reimbursement - 2010 Issue 5
READER QUESTION: Consider Using Incident-To Guidelines When Billing Follow-Ups
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Article Overview
This article reviews Medicare incident-to billing for follow-up visits performed by non-physician practitioners. It focuses on the general requirements for an established plan of care, supervision expectations, and practitioner qualification considerations that billing staff and clinicians should verify before submitting claims. The discussion is aimed at practices that bill Medicare and need to understand when follow-up services may be reported under incident-to arrangements.
Why This Topic Matters
Incident-to billing can affect how follow-up services are reported under Medicare and which provider NPI is used on the claim. Understanding the applicable supervision and qualification framework helps practices avoid billing errors and supports compliant claim submission.
What You Will Learn
- The general Medicare incident-to framework for follow-up visits
- How established plans of care relate to incident-to billing
- Why supervision and practitioner qualification matter for reporting services
- What billing staff should verify before using incident-to billing arrangements
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physicians
- Non-physician practitioners
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