Wiki Incident-to-Billing

[bpope1]

My office is debating the incident to rules. To my knowledge in order to bill incident to the physician has to be in the suite/clinic. We have an office that is connected to the hospital by a hallway and some are saying that we can bill under a physician that is on call at the hospital because that physician does go between the office and the clinic while on call. Any knowledge on this subject would be very helpful!

 

[CatchTheWind]

No, the physician has to be actually physically present in the "office suite." The parts of the hospital outside the doctor's office are not considered part of the office suite, nor does "coming and going" qualify as being present.

 

[ElaineM]

There are specific definitions and criteria for incident-to billing.
It can be found in the IOM Medicare Benefit Policy Manual. Publication 100-02 Chapter 15, sections 60 through 60.4.

We had to read and re-read this information and call and ask many questions to make sure we were in compliance. There are quite a bit of criteria to meet.
But if you meet the requirements, you should definitely be receiving the additional money the practice is entitled to.

Noridian had a simple three-page document that defined incident-to well.
It was dated December 15, 2010. You might find that in an internet search...

Elaine