# Proper Billing of Incident To



## sharynwolfe (Aug 27, 2013)

I have hit a snag with Humana and "incident to" billing. They are telling me that they follow Medicare guidelines which means that the claims that I am billing "incident to" for are only to have the supervising physicians information on them. They say to make the rendering provider on the HCFA whomever the supervising physician was and leave the NP off completely. Humana is now going through my claims and asking for money back on the claims that they paid 100% for when there was the supervising physician and the NP on the claim. They are trying to reimburse me at the 85% for the NP.
I almost find it fraudulent however per the documentation that was given to me this may be correct. Can anyone give me some insight on this? And is this new?


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## capricew (Aug 27, 2013)

Actually this is correct.  
You can bill incident to as long as the supervising physician has already established a plan of care for the patient.  Then when the NP or PA-C sees the patient by themselves, the encounter can be billed under the supervising physician as long as the supervising physician in in the same office suite at the time the NP/PA-c see's the patient.  
Now, if the NP or PA-C sees the patient for a problem that has not previously had a plan of care established by the physician- you cannot bill incident to.  So if the NP or PA-c sees the patient for regular follow up, but the patient brings up a new problem, then the visit must be billed under the NP or PA-c.  
Any visits billed under the NP or PA-c directly are payable at 85% of the Medicare allowable for the physician visit.  
Hope this helps


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## sharynwolfe (Aug 28, 2013)

*Thanks*

OK thanks - to me it is just weird not to have anything on the HCFA that says the service was done by the NP. To say the Rendering provider is someone that didn't see the patient that day feels wrong . Thank you for taking the time to respond, I appreciate the info.


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## capricew (Sep 5, 2013)

your welcome!
and the documentation will show who actually saw the patient.  
As long as you can prove by your schedule or a log sheet of the doctor being in the office at that time then all is good.  The doctor doesn't even have to sign off on each note a midlevel provider completes.  He just has to have input to the plan of care on occasion and when new problems arise.

Good Luck!


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## catorres (Dec 31, 2013)

*Diabetic Teaching*

Can a MD refer a patient to his nurse an RN for Diabetic teaching due to the medication?
Or can a physician refer an asthama patient who has asthma to teach proper use of the inhaliar? And bill as "incident to"

I'd appreciate any help.


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## sparkles1077 (Dec 31, 2013)

catorres said:


> Can a MD refer a patient to his nurse an RN for Diabetic teaching due to the medication?
> Or can a physician refer an asthama patient who has asthma to teach proper use of the inhaliar? And bill as "incident to"
> 
> I'd appreciate any help.



Yes, the RN can provide the education as long as there is an order from the physician and adequate documentation.  This is billable as a 99211 and is incident to the physician.


I have a question as well for anyone who can assist:

Office visit:  NP documents indicates she dictates for physician.  Most of the documentation appears to be hers, except in the A and P where she indicates the doctor performed an exam and formulated the A and P.  Scribe requirements are not met.  It is evident from the note that patient has been following plan of care led by the physician.  Would you code this as incident to?

Thank you for any help, 
Sparkles


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## jkh429 (Mar 5, 2015)

Does anyone know where I can find these guidelines in writing? I have been trying to call Humana all day today regarding this. However, I keep getting transferred to people that don't know what incident-to billing even is. 
Any help would be greatly appreciated! Thanks in advance


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## mitchellde (Mar 5, 2015)

You can look it up on line and in the medicare manual using incident to as your look up words.


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## millbj (Mar 6, 2015)

Debra-

Do you know if billing with POS 22 can it be incident to or does it have to be split/shared billing for  NPP?


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## mitchellde (Mar 6, 2015)

You cannot bill outpatient services incident to.  You can bill shared services provided the documentation meets the requirements.


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