Everything You Want To Know About “Incident To Billing”

EVERYTHING YOU WANT TO KNOW ABOUT “INCIDENT TO BILLING”

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EVERYTHING YOU WANT TO KNOW ABOUT “INCIDENT TO BILLING”

MGMA has reported that many physician-owned multi-specialty practices and groups often use non-physician providers (NPPs). According to the report, the reason is that the NPPs with the practices often generate higher income than physicians and are financially more viable.

NPPs, however, need to function directly under the supervision of a physician to provide billable medical services. Therefore, registered nurse aestheticians, surgeons, or physicians’ assistants can be included in the facility under the NPPs. Further under the Medicare fee schedule, the NPPs’ medical practices can receive full payment and reimburse the amount for the services successfully by reporting the NPSS services under ‘incident-to’ for physician care.

But CMS has implemented strict and complex guidelines for incident-to billing. That’s why physicians must understand the rules of the medical billing procedures correctly to receive full payment from the insurers for the services rendered by NPPs. The physicians/ billing staff also need to be aware of any misapplying of the conditions in the incident-to billing. Misapplication of the condition in the medical billing and coding further increases the chances of coming under the CMS’s radar for fraudulent claims.

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EVERYTHING YOU WANT TO KNOW ABOUT “INCIDENT TO BILLING”

Hence, most centers that offer NPPs prefer to work with medical billing services to overcome the challenges of incident-to billing.

What Should Physicians Know About Incident-To Billing?

There is quite a bit of ambiguity in the term ‘supervising physician.’ The CMS states that a medical billing or supervising physician does not necessarily have to be the original physician or ordering physician on the patient’s case.

How Are Incident-To Services Coded?

Additional modifiers are not required when coding for incident-to-services. Instead, the standard CPT, HCPCS, and ICD codes can be used.

How To Be Incident-To Billing Complaint?

The failure to have proper incident-to-billing compliance can mean a massive amount of settlements being paid for the failure to comply with the rules. For instance, in February of 2020, a family physician in Ohio had to pay $285,000 to settle the allegation of failure to supervise nurse practitioner services billed at a higher physician rate.

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EVERYTHING YOU WANT TO KNOW ABOUT “INCIDENT TO BILLING”

Undoubtedly, training your staff and staying on top of the changing regulations can be a challenge. But simultaneously, when you partner with an expert medical billing and coding company that specializes in incident-to billing such as 24/7 Medical Billing Services, you will soon experience the benefit of having NPPs service. Also, you can enjoy the benefit of having an efficient revenue management cycle in place for better ROI while increasing the scalability of your facility by outsourcing medical billing and coding.

HTTPS://WWW.247MEDICALBILLINGSERVICES.COM/

EVERYTHING YOU WANT TO KNOW ABOUT “INCIDENT TO BILLING”

About 24/7 Medical Billing Services: 24/7 Medical Billing Services is the nation’s leading medical billing service provider catering services to more than 42 specialties across the entire 50 states. You can rely on us for end-to-end revenue cycle management. We guarantee up to 10-20% increase in the revenue with cost reduction of your practice for up to 50%.

Call us today at 888-502-0537 to know more on how we can help boost profitability for your practice.

Media Contact: 24/7 Medical Billing Services, Ohio: 28405 Osborn Road, Cleveland, OH 44140 Georgia: 3001 Greenfield Drive, Marietta GA 30068 Tel: + 1 -888-502-0537

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