Physician's authorization of NPP's services is a rule you can't miss. The Centers for Medicare and Medicaid Services (CMS) recognizes nonphysician practitioners (NPPs) for payment purposes by reimbursing physicians for services provided "incident to" a physician's care. However, CMS has made it clear in 2008's Transmittal 87 that payers will not reimburse these services unless there is physician documentation authorizing the incident-to service. You could end up dazed and confused if you don't fully understand incident-to rules. But you can't afford not to -- Medicare reimburses at 100 percent of the physician fee schedule when billed in the physician's name as an incident-to service, and 85 percent when billed under the NPP's name if incident-to guidelines are not fulfilled. Fortunately, you have ways to level up your knowledge about incident-to services. Here are 3 important guidelines. 1. Meet CMS-Set Criteria CMS' Benefit Policy Manual defines "incident to" as "services furnished as an integral although incidental part of a physician's personal professional service." CMS pays NPP office service reported under a physician's NPI at 100 percent, provided you meet these requirements: A Must: 2. Document Supervision Since 2008, CMS has pushed for the physician to document his approval of an NPP to provide follow-up services. Example: The initial physician service in this case is reported as 99203 (with 1.42 RVU) under the physician's NPI, which should get you about $74 in reimbursement. Additionally, follow-up services are reported (e.g., 99213) under the physician's NPI after being provided "incident-to" the physician's plan of care. The NPP should provide evidence of the required physician supervision. This can easily be accomplished through a simple notation in the record, such as "Service performed under the supervision of Dr. Smith." A co-signature is not required for billing purposes, but may be required for licensure issues involving physician assistants. 3. Be Aware of NPP Limitations When a patient comes to the office when no physician is around, the NPP can see and treat her. The NPP can even provide a service within his or her state law guidelines for scope of practice as long as the state's supervision requirements are met. Option: