Incident to

Many practices today employ Nurse Practitioners (NP’s), Physician Assistants (PA’s), as well as many other types of Non Physician Practitioners (NPP’s). These NPP’s are an integral part of the practice and patient care within the practice. Compliant documentation and billing for the services they provide is important. How does your practice bill for these services? And what percentage of your Medicare physician fee schedule are you being reimbursed for these services? 

  • Independent billing – 85%
  • Split/Shared services- 100%
  • Incident to – 100%

What are the documentation requirements for each one of these types of billing scenarios and does your NPP and provider documentation support these requirements?

  • Independent billing

1) Inpatient or Outpatient setting?

2) Has a plan of care been established by the physician?

3) Is the physician also available in the hospital or suite to see or assist with the patient?

  • Split/Shared Services

1) Inpatient or Outpatient setting?

2) Has the physician also seen the patient?

  • Incident To

1)Inpatient or Outpatient setting?

2) Has a plan of care been established by the physician?

3) Is the supervision guideline being met?

These are all important factors to consider when determining how to bill for you NPP services. You must then ensure that your documentation is compliant with these regulation