Keep in mind, the incident-to billing guidelines were developed by Medicare, and private insurance carriers do not necessarily follow this process. Some commercial carriers have specific guidelines that require all practitioners (physicians, NPs and PAs) to bill under their own name and provider identification number.
CMS’s incident-to requirements and guidelines may be found in the CMS Claims Processing Manual, the CMS Benefit Policy Manual, the CMS website, CMS transmittals, MedLearn Matters, etc., at www.cms.gov.
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See this month’s Coding Corner for an example of incident-to billing. For additional information or assistance with coding and billing guidelines, contact ACR practice management staff via e-mail at [email protected].
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Key Points
- Medicare provides reimbursement for NPP services that are incident to a physician’s care.
- When billing incident-to services, a practice can be reimbursed at 100% of the physician fee schedule for NPP services.
- Failing to bill for incident-to services can mean leaving money on the table for a practice.
References
- CMS. Medicare Benefit Policy Manual. Chapter 15—Covered Medicare and Other Health Services. Dec. 31, 2014.
- CMS. “Incident to” Services. April 9, 2013.
- CMS. CMS Manual System. March 1, 2013.
