Incident to Billing
Service provision in health facilities is usually offered by the health care team, including the nurses, physicians, clinicians, among others. However, the providers have different roles with others performed exclusively by physicians or nurses only. The incident-to services which were introduced sought to make service provision better, but it is easily confused at a time due to its unclear rules. This paper will explain its meaning, its requirements, and the importance of the nursing practitioner to know how the employer bills services.
Incident-to services are the ones that are billed to Medicare by physicians, but they do not perform themselves. The services are usually carried out by non-physician health care providers under close supervision by the physician (Alam, 2015). Therefore, they are service that needs a physician to be around to offer direction when there is need. The authority to bill for the services is provided by the Social Security Act, which includes coverage of Medicare supplies and services provided incident to professionally by the physician (Alam, 2015). The main reason for the eligibility of the service is that it is offered as a necessary but incidental part of professional services delivered by the physician during diagnosis and treatment.
To be able to come into the realization of the incident-to billing benefits, the set rules must be duly followed. One of them is that it applies only to Medicare; thus, services with its benefits cannot be considered; for example, diagnostic tests (Verhovshek & Verhovshek, 2018). Also, services that are billed incident-to should not take place in an institutional setting such as a skilled nursing facility or a hospital. Besides, the incident-to require that services offered to patients in the first do not meet the category of the incident to or in the case where there is a change in the care plan (Verhovshek & Verhovshek, 2018). In this case, physicians who are Medicare-credentialed must start the patient care, and if the patient comes in with a worsened complain, initial evaluation and management must be conducted. Furthermore, non-physician practitioners can provide follow-up services after the initial visit under direct supervision by the physician. However, it does not mean that the physician must be in the room but must be present in the office suite to offer guidance when needed (Verhovshek & Verhovshek, 2018). Other requirements state that the physician must be intimately involved in the course of treatment, both the qualified and the Medicare-credentialed physician needs to be employees of the group entity billing and, finally, the incident to service must be the kind that can be carried out in an office setting.
Incident to services as it applies to Medicare is prone to changes. Besides, different states have scopes of practice for NP, which are not similar; therefore, understanding the employer requirement is significant in reducing confusion that may arise in the whole process (Oliverez, 2017). There have been cases of dual payment, and thus, having good knowledge of what the employer bills will help in reducing the instances.
Conclusively, incident- to services are very useful to individuals seeking care because it gives the patient the chance to be offered by non-physician practitioners (NPP), though under supervision. Some requirements need to be considered to facilitate service providers such as primary care that must be attended by the physician, and NPPs need to offer services under direct supervision. Also, it is necessary to understand how the employer incident-to billing to minimize confusion that may occur.
References
Alam, M. (2015). Coding for “Incident-to” Services. Retrieved 30 October 2019, from https://www.mdedge.com/dermatology/article/100354/practice-management/coding-incident-services
Oliverez, M. (2017). Coding and Billing for NP and PA Providers in Your Medical Practice. CaptureBilling.com - Medical Billing Services. Retrieved 30 October 2019, from https://capturebilling.com/coding-and-billing-for-np-and-pa-providers-in-your-practice/
Verhovshek, J., & Verhovshek, J. (2018). Seven Incident-to Billing Requirements - AAPC Knowledge Center. Aapc.com. Retrieved 30 October 2019, from https://www.aapc.com/blog/44912-seven-incident-to-billing-requirements/
