Want to collect an extra 15% for your providers’ services? Who wouldn’t? If the provider in question is a nonphysician practitioner (NPP), you may be able to do so if you master incident to billing.
Check out five tips that will help you bring in maximum pay for your NPP’s incident to services.
1. Make Sure the Office Is the Place of Service
The concept of incident to billing doesn’t exist in the inpatient setting, so you should always use place of service 11 (Office) when submitting incident to claims. There are some rare exceptions when patients are homebound and the NPP goes to the patient’s house in an underserved area, but in most instances, POS 11 will be your go-to code for in-office incident to services.
2. The Patient Must Be Established
You can report incident to services for established patients only, and here’s why: The physician must see the patient first and create the plan of care. The NPP then follows that plan of care every time they see the patient. Because no plan of care would be established for a new patient, these initial visits are not covered under the incident to billing guidelines.
3. The NPP Must See the Patient for an Existing Issue
If the patient presents with a new problem that the physician has not previously seen (and hasn’t created a plan of care for), then the NPP cannot bill incident to. The NPP can still see the patient (assuming the visit meets state licensing laws), but they’d have to report the service under their own NPI and not using the physician’s. That means the NPP would collect 85% of the fee for the visit. Alternately, the NPP could call the physician in to see and treat the patient, and the physician would then bill the visit under their own NPI.
4. The Physician Must Be Present and Immediately Available
Incident to services can only be reported if there’s direct physician supervision on the date of service, meaning the doctor is present and immediately available in the office suite if needed. “Immediately available” means the physician should be able to come to the NPP’s side right away if necessary. For instance, if the doctor is performing an intricate hand surgery in the same building, they wouldn’t be considered immediately available, even though the doctor is in the suite.
5. The NPP and Physician Should Be Employed by the Same Group
Both the nonphysician provider and the physician should be employed by the same entity. They can be independent contractors, leased employees or employees, but their contracts should be with the same employer as each other.
Don’t settle for collecting 85% of the fee when your nonphysician providers perform incident to services. Get expert tips from expert Jennifer Swindle RHIT, CCS, CCS-P, CDIP, CPC, CIC, CPMA, CEMC, CFPC, during her latest online training, NPP Incident-To: Use Supervision to Maximize Your Reimbursement. Register today!
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