Wiki INCDIENT 2 BILLING

[TAVARGA70]

for incident 2 billing, do advantage plans allow and follow same guidelines as medicare?
thank you

 

[csperoni]

for incident 2 billing, do advantage plans allow and follow same guidelines as medicare?
thank you

You would have to check your contract with the carrier. From my experience, yes, but your contracts could differ.

 

[TAVARGA70]

thank you ....appreciate the help with this
one last question, reading the guidelines, is it true or false to say that the MD that established the original plan of care is also to be the supervising to the NP for future care? or can another MD in the office be that supervisor if the MD is out of the office? basically we have 7 same speciality MD's with a rotating office schedule. I was told that in order to bill incident 2 that only the original MD who established the plan of care and if the patient comes in to the office on a day MD is out, will need to bill under NP.
hoping this makes sense.... thank you in advance

 

[csperoni]

The physician who determined the plan of care does NOT need to be the onsite supervising physician. The onsite supervising physician would be the billable provider if the rest of the service meets incident to and the carrier follows incident to.
From NGS:
Direct supervision by a physician is required.
Incident to billing requires direct supervision by the supervising physician who must be present in the office suite and immediately available and able to provide assistance and direction throughout the time the service is performed
The supervising physician does not have to be in the same room but must be in the office or clinic suite
For group practices, any physician member of the group may provide supervision to NPPs under this guideline.

 

[toria11]

The physician who determined the plan of care does NOT need to be the onsite supervising physician. The onsite supervising physician would be the billable provider if the rest of the service meets incident to and the carrier follows incident to.
From NGS:
Direct supervision by a physician is required.
Incident to billing requires direct supervision by the supervising physician who must be present in the office suite and immediately available and able to provide assistance and direction throughout the time the service is performed
The supervising physician does not have to be in the same room but must be in the office or clinic suite
For group practices, any physician member of the group may provide supervision to NPPs under this guideline.

I'm trying to find information on which commercial carriers accept incident-to billing (in FL). Currently, we are only billing incident-to to Medicare/Medicare advantage plans and commercial UHC (w/ the SA modifier). Recently, I've seen other users talk about billing Aetna, Cigna, Humana, etc. for incident-to (and some also requiring the modifier). Do you happen to have any resources or experience with this? I've searched the carrier websites and have not found a specific incident-to policy. Thanks!

 

[csperoni]

I'm trying to find information on which commercial carriers accept incident-to billing (in FL). Currently, we are only billing incident-to to Medicare/Medicare advantage plans and commercial UHC (w/ the SA modifier). Recently, I've seen other users talk about billing Aetna, Cigna, Humana, etc. for incident-to (and some also requiring the modifier). Do you happen to have any resources or experience with this? I've searched the carrier websites and have not found a specific incident-to policy. Thanks!

The problem with relying on someone else's list is that my contract with Aetna could be different than your contract with Aetna. Particularly, large healthcare systems are able to negotiate different contracts and/or fee schedules. When it comes to situations like this, having a reference from the carrier in writing (whether your provider contract or their policy) is essential.