Gastroenterology Coding Alert

Question: We have two physician assistants at our GI practice, but we recently heard that we won’t be able to bill their services incident-to anymore. When will this begin?

Codify Subscriber

Answer: What you probably heard about incident to was that the Medicare Payment Advisory Commission (MedPAC) recommended that Congress eliminate the incident to program, and instead have nurse practitioners (NPs) and physician assistants (PAs) bill Medicare directly for their services at the 85 percent rate, notes MedPAC’s quarterly report. The reasoning behind this policy suggestion is threefold and surrounds billing transparency, boosting primary care, and saving CMS money, since NPs and PAs can collect 100 percent of the fee schedule amount if they bill incident to the physician.

“Given the growing roles of NPs and PAs and their shift away from primary care, Medicare’s ‘incident-to’ rules and lack of specialty data create several problems, including obscuring important information on the clinicians who treat beneficiaries and inhibiting Medicare’s ability to identify and support clinicians furnishing primary care,” MedPAC says.

This isn’t the first time MedPAC has discussed problems with incident to. In fact, the June quarterly report doubles down on issues covered in the Commission’s December meeting. However, the feds don’t always follow through on MedPAC suggestions, and sometimes they slow walk implementation of unpopular recommendations.

Keep an eye on Gastroenterology Coding Alert for developments on this topic. If Congress votes to adopt MedPAC’s recommendation, we’ll share a full breakdown of what it means to your practice.