Wiki NPP/PA - Incident-To Billing

[laurenortho]

Hello!

This may be a dumb question but I can't seem to find it on Google..

How come SOME Commercial Carriers recognize and follow incident-to guidelines, and others do not?

 

[mitchellde]

Most do but if they do not then the policy must indicate that they do not follow the Medicare policy and recognize that when the MD number is used it may be an NPP encounter where the MD may not be on site and may not have previously examined the patient. Also you will have some state laws that will prevent using an MD number for NPP encounters.

 

[JCaillouet]

Agreed.

What's the carrier? If they follow Medicare's payment guidelines they will follow the incidental to policy.

I'm having a 'lot' of claims where I work at deny for that.