Wiki Incident to

[mhstrauss]

Is this an appropriate use of Incident to billing, based on CMS Guidelines? I have read the guidelines, but this particular situation doesn't seem to be covered.

Can a new PA, who has not completed credentialing for any payers yet, see Medicare patients under Incident to billing, if all other requirements are met? My gut instinct is saying no, since the PA is not yet credentialed with Medicare, but I want to be sure before I advise the clinical staff. I appreciate any guidance anyone can offer.

TIA!!

 

[Pat Liebl]

If a PA is not credentialed with Medicare you can not bill incident to. Incident-to a physician service billing never, never can be used in a hospital, either outpatient or inpatient setting.

 

[mhstrauss]

If a PA is not credentialed with Medicare you can not bill incident to. Incident-to a physician service billing never, never can be used in a hospital, either outpatient or inpatient setting.

Thanks Pat! This is in a clinic setting though; does that make a difference?

 

[erjones147]

It is my understanding that the PA does not have to be enrolled with Medicare, as long as all the other incident-to conditions have been met (e.g. first exam by an MD/DO establishing plan-of-care, supervising MD onsite for consultation, etc.)

The PA would see the patient, and you would bill the MD/DO's NPI

http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/SE0441.pdf

and

https://med.noridianmedicare.com/web/jeb/topics/incident-to-and-npp-services (section 3 under "Criteria")