If you are a Medicare physician, it’s important that you get maximum reimbursement for the services provided to keep your practice afloat. To get 100% reimbursement from Medicare, services and supplies must be properly provided and properly billed incident-to a physician’s or a non-physician practitioner’s (NPP) services. This provides a chance for practices to make most of their auxiliary personnel as long as they strictly adhere to the incident-to guidelines created by the Centers for Medicare & Medicaid Services (CMS).

  • As per Medicare’s Benefits Policy Manual, coverage of services and supplies provided in an outpatient setting should be furnished as part of the provider’s professional services in the course of diagnosis or treatment of an injury or illness. The provider could include physicians, nurse practitioners, clinical nurse specialists, certified nurse midwives, physician assistants, clinical psychologists, clinical social workers and physical and occupational therapists. Auxiliary personnel providing services should be supervised by the physician. When medical billing for incident-to service is prepared, it should be prepared in the name of the supervising physician.
  • To get reimbursement for incident-to services, a physician or qualified NPP must have had a face-to-face encounter with the patient who has been provided with the incident-to service. So new patients will not get the benefit of this service. Medicare’s Benefits Manual also states that a physician’s active participation is necessary in engaging patient-care which means that the physician cannot turn-over care to NCPs. At the same time, the physician does not have to render a personal service for each encounter that is incident-to.
  • Incident-to services that involve services or supplies that are of a type not accepted as medically appropriate to provide in the medical practice environment are not covered under the incident-to reimbursement provision.

Physicians need to be aware if they submit incident-to claims that do not meet the rules, these claims are considered to be potentially false. The best way for practices to ensure accurate, hassle-free incident-to reimbursement is to outsource their billing tasks to a professional medical billing company. A reliable service provider’s teams of expert coders and billing specialists can ensure professional medical billing and coding services to avoid rejections and maximize reimbursement.