Part B Insider - 2015 Issue 10
Billing: Grasp 'Incident-to' Opportunity for NPP Pay
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Article Overview
This article covers Medicare incident-to billing as it applies to non-physician practitioners in a physician practice, with emphasis on the general requirements for using the method, the supervision framework, and the reimbursement impact of billing under different provider identifiers. It is relevant for medical coders, billers, practice managers, and compliance staff who want to evaluate whether incident-to billing may apply in their office or home-based services and how payer policies can affect payment.
Why This Topic Matters
Incident-to billing can materially affect reimbursement, but it depends on strict Medicare conditions and may not be recognized by every payer. Understanding the scope of the policy helps practices avoid billing under the wrong provider identity and assess when full physician-level payment may or may not be available.
What You Will Learn
- The general Medicare framework for incident-to billing
- How direct supervision affects billing eligibility
- What types of practice and place-of-service situations are discussed
- How reimbursement can differ between physician-billed and NPP-billed claims
- Why payer-specific policy differences matter for incident-to claims
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Compliance staff
- Physician office administrators
- General surgery practice staff
Codes Discussed
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