Pathology/Lab Coding Alert

Billing Corner:

Don't Ignore Incident-to Rules or You Could Harm Your Bottom Line

Hint: The key is recognition and supervision

If the term "incident-to" leaves you perplexed, our experts help you to break down Medicare's guidelines and avoid mistakes when billing nonphysician services. Only Bill for Recognized Practitioners, Please Only physicians and certain nonphysician practitioners recognized by Medicare can bill for services they provide incident-to a physician's professional service. And the recognized provider rendering the service must be practicing within his scope of practice as defined by state law, says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia. Pathologists' assistants are not recognized providers, according to Medicare. Physician Performs Initial Service To bill under a physician's provider number, the physician must see the patient before any incident-to services begin. Medicare's incident-to guidelines state that a physician must institute a plan of care, and then the nonphysician practitioner can follow up with the patient, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. Get Straight Answers on 'Direct Supervision' Another important incident-to billing requirement is that the nonphysician practitioner must provide the services under a physician's "direct supervision." Direct personal supervision does not mean that the physician must be present in the same room with the nonphysician practitioner, Falbo says. Rather, the supervising physician must be in the office suite and immediately available to provide assistance and direction to the nonphysician practitioner, she says. You'll have to document the supervision.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Pathology/Lab Coding Alert

View All