Knowing when to bill for “incident to” professional services can be challenging. Novitas Solutions introduced an “incident to” self-service tool on Jan. 25, 2016, designed to offer assistance to providers with understanding “incident-to” requirements, applying the guidelines to their individual situation, and interpreting documentation requirements. Through a series of “yes” or “no’ questions, the interactive tool guides the user in determining if “incident-to” rules apply. Definitions are available within the tool to ensure users are clear on the guidelines and requirements for each question.
The 2016 Medicare Fee Schedule Final Rule provided clarification around “incident to” requirements. PAMED was advised that the rule “is intended to clarify that the ordering physician or other practitioner and the supervising physician or other practitioner DO NOT need to be one in the same. Rather, the proposal is intended to clarify that the physician or other practitioner who bills for the “incident to” services must always be the supervising physician or other practitioner.”
Despite this explanation, it may still be arduous to determine if services provided by a non-physician practitioner can be billed under a physician’s NPI, and the incident-to self-service tool is designed to help.
If you have specific questions about the “incident to” tool, contact PAMED’s Knowledge Center at
855-PAMED4U, that’s 855-726-3348.