Q: What is incident-to billing?
A:The incident-to term is used by Medicare. It simply means that a Nurse Practitioner or Physician Assistant, can bill for service under a supervising physician national provider number which will be reimbursed at 100 percent of the allowable Part B Physician Fee Schedule. This physician must be on site in the suite but is not required to be in the examination room.
Q:What type of patient's can a NP/PA see in the practice?
A:To receive incident-to reimbursement; they can only see established patient with established diagnoses.
Q:Can a NP/PA see other patients in the practice?
A:Yes they can see new patients and established patient with new problems, but they will have to bill under their own NPI and receive 85 percent of the allowable Part B Physician Fee Schedule.
Q: 4. What happens if the NP/PA is seeing an established patient with an established diagnosis and a new problem is discovered?
A:Either the NP/PA can continue to treat the patient and bill the visit under their own NPI and receive 85 percent of the allowable Part B Physician Fee Schedule, or they can have the supervising physician restart the visit with the patient. It is not allowable to simply have the supervising physician to add their notes concerning the new issue. This is considered a shared visit and a shared visit is not allowed for office or outpatient services.
Q:Does incident-to billing apply to private carriers?
A:Some carriers will except incident-to billing; but practices will have to verify with each carrier to determine their guideline on the issue.
For more information or additional questions, contact Antanya Chung at .
