Gastroenterology Coding Alert

Presented by Trish Bukauskas-Vollmer, CMM, CPC, CMSCS

The following supplement to Gastroenterology Coding Alert is the transcript of a teleconference presented by The Coding Institute. To obtain the slides for the conference, please log on to our Online Subscription System at http://codinginstitute.com/login and download the current issue, and the slides will be contained therein. If you're not sure how to use the Online Subscription System or need help downloading the issue, please contact our customer service department at 1-800-508-2582 or service@medville.com, and one of our representatives will be able to assist you.

The speaker for the teleconference, Trish Bukauskas-Vollmer, CMM, CPC, CMSCS, has over 19 years in the medical field.  She currently is the president and CEO of T.B. Consulting, a firm specializing in education, consulting, auditing, compliance and initial start-up of medical offices and clinics. She is a certified medical manager through the Professional Association of Health Care Office Managers (PAHCOM) and a certified professional coder (CPC) with the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA). She is also an active member of the American Society of Interventional Pain Physicians (ASIPP). She presents seminars and coding workshops across the country. Hi everybody. Today's topic, we are going to talk about incident-to non-physician providers.  Everyone in a medical practice needs to know how to bill and be reimbursed for non-physician practitioners and incident-to services.

Medicare can reimburse for non-physician practitioner services that are incident-to.  In addition to just nurses, there are also nurse practitioners, physician assistants, clinical nurse specialists, biofeedback techs, respiratory therapists, physical and occupational therapists, psychologists, midwives, x-ray techs, lab techs.  These non-physician providers do not just assist physicians.  They often see patients in the physician's absence.  Due to managed care and capitation, this development creates incentives to save costs by using the least expensive best-trained personnel to meet the patient's needs.

With managed care and malpractice insurance and everything, physicians are often losing revenue.  The only way that they can capture additional revenue is to hire additional help, whether it would be another partner, another physician or to double their volume.  They only way they can double the volume of the number of patients they are seeing without adding another physician and becoming a partner or a large cooperation is to hire either a PA or a non-physician practitioner or a nurse practitioner, midwife, CRNAs, things like that, and there are a lot of different guidelines to do that.  Orthopedics is growing leaps and bounds in the amount of PAs and nurse practitioners that they are hiring now.

The reimbursement of incident-to, failing to bill for services, even if they occur only four times a day, can cost your practice as much as $20,000 a year.  [...]