Urology Coding Alert

Knowing the rules determines 100 percent vs. 85 percent reimbursement. In the office setting, incident-to billing is an essential gear in a urology practice's reimbursement machine. Each time a nonphysician practitioner (NPP) provides services or treatment to a Medicare patient, you should be on the lookout for the opportunity to code the service incident-to the physician. Why? Under incident-to rules, qualified NPPs can treat certain patients and still bill the visit under the urologist's National Provider Identifier (NPI), bringing in 100 percent of the assigned fee for the codes you report. But if you aren't following the stringent incident-to billing rules, you're only setting your practice up for lost reimbursement and possible fraud charges. Make sure you're capturing every dollar your NPPs deserve with these expert tips. 1. NPP Has to Follow Established Plan of Care To qualify for incident-to billing, the urologist must see the patient during an initial [...]