Wiki NPP Billing Incident-to

Create Wiki Sort by votes
F

FreemanR

New
Messages
5
Location
Rome , GA
Best answers
0
I have a question pertaining to Incident-to billing. I know Medicare's Incident-to guidelines but my question is in regard to Commercial payers. I have pulled up policies for BCBS Anthem, UHC and Cigna and I want to make sure I am understanding correctly. If a NPP see's an established patient and he/she makes no changes to the patient's plan of care, and if that NPP has their own NPI # would I bill the rendering and supervising under the NPP's NPI# or would I bill the NPP under the rendering and the Supervising under the Provider's NPI?

Now if an NPP see's an established patient and does make changes to the plan of care, would I bill incident-to Rendering under the NPP's NPI and Supervising under the Provider's NPI or would I bill totally under the NPP as the rendering and supervising?

I know if it is a new patient I would only bill under the NPP's NPI #. Again, I am asking in regards to Commercial payers. Reading these guidelines has me a little confused and I want to make sure these claims are being billed out correctly.

Thank you!
 
0
1. If a NPP see's an established patient and he/she makes no changes to the patient's plan of care, and if that NPP has their own NPI # would I bill the rendering and supervising under the NPP's NPI# or would I bill the NPP under the rendering and the Supervising under the Provider's NPI? ANSWER -- If no changes under plan of care billing would be under Physician NPI #. NPP is only allowed to bill under his number when a new problem is addressed by them during the course of visits.

2.if an NPP see's an established patient and does make changes to the plan of care, would I bill incident-to Rendering under the NPP's NPI and Supervising under the Provider's NPI or would I bill totally under the NPP as the rendering and supervising? - It should be under NPP's Number.

My responses are from my Compliance studying guide. Hope this helps.

Thanks
Vani Sahni
 
1
The concept of "incident-to" is a Medicare rule. While some commercial payers may follow, you would need to check their specific NPP billing guidelines to see if they even recognize it.

Reference:


Anthem CO Example:
III. The Health Plan does not follow CMS “Incident to” reimbursement rules for any physician or non-physician provider (NPP) who has been assigned or is waiting for his/her own NPI. Therefore:  If a provider has an NPI and is recognized by the Health Plan as eligible to submit claims directly to the Health Plan, the provider is required to report his/her services under his/her own NPI  Separately reportable “Incident to” services are only eligible for reimbursement under the supervising provider’s NPI if the specific type of NPP or qualified auxiliary office personnel who rendered the services is ineligible to submit claims directly to the Health Plan; this rule will apply even when a provider is in the process of applying for his/her own NPI number.

Some providers and practices may have internal policies that prevent incident-to billing due to risk.
 
You must log in or register to reply here.
Top