Wiki Incident-to Clarification

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Savannah

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I need some clarification on Billing Incident-to. I say that in order to BILL Incident-to Correctly the Physician MUST be in the same building as the PA/NP. My practice wants to utilize our PA/NP at a Satellite Office (and Bill Incident-to) without a Physician Present but available by phone because the scope of Practice for a PA per GA Composite Medical Board states " The supervising physician need not be physically present at the time of the services but shall be immediately available by telecommunications". My opinion is that Scope of Practice and Billing are different. You need to follow the Insurance Companies definition of Incident-to. Please help clarify this for me. Paula
 
Scope of practice just means they can perform the service. It's not related to the reimbursement of the service. So in this case the PA can perform and bill under their own NPI. It needs to meet both incident-to & scope of practice for it to be billable under the Supervisors name.
 
I agree and you are correct that scope of practice and 'incident to' are completely separate things. You can find this in the Medicare Benefit Policy Manual, Chapter 16, section 60: 'Incident to' in the office requires that services be "furnished by the physician or by auxiliary personnel under the physician’s direct supervision....Direct supervision in the office setting does not mean that the physician must be present in the same room with his or her aide. However, the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the aide is performing services."
 
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