Wiki Incident to billing

[clopez]

Good morning,

An urgent care center is billing incident to. I'm finding it hard to understand how can they meet the requirements of incident to billing when patients seek care once for acute illnesses, injuries and maybe exacerbation of chronic disease. In my mind I see it's hard for an MD to see a patient where he/she diagnose and establish a plan of care to follow up with a NPP in that same setting, from experience they always have patient follow up with PCP.

Anyone can shed some light or guide me to literature where I can verify or anyone can give me scenarios of when is it okay to bill incident to in this setting location.

Thank you

 

[mitchellde]

It is not ok to bill incident to in the urgent care setting. This is acceptable only in the physician office setting, POS 11. The problem is the payers will never know that an NPP is the one attending to the patient unless a payient issues a complaint and the medical record clearly shows the service was perfomed by the NPP and charged out as a physician service.

 

[talton0206]

There seems to be a massive misunderstanding about the incident to guidelines. Somewhere along the line, someone must have given out a bunch of bad info. People seem to think that the only criteria is that a physician be in the office. I debated it with our administrator and came dangerously close to losing my job. I finally did a Incident-to Decision Tree and attached the guidelines. I'll try to figure out how to attach it or insert a screen shot of it tomorrow or Friday. (We may be out due to slick streets tomorrow.) In the meantime, try Googling "incident to decision tree" and you may find the one that I stole the idea from.