Lately, we have noticed a lot of confusion from providers regarding billing “incident to” services. We have come across many practices that don’t know the guidelines and have questions on how to bill for incident-to-services.

Let’s review the basics.

What is incident to services?

“Incident to” is a billing policy for mid-level providers to bill under the physicians NPI. In order to bill like this, you must know the guidelines.

What are the guidelines?

Per Medicare, in order to bill “incident to”, the services must be part of your patient’s normal course of treatment. The physician must perform the initial treatment and be actively involved throughout the entire course of treatment. The physician does not have to be present in the patient exam room, BUT the physician must be present in the office suite. This ensures the physician is present to provide assistance if it is needed.

A lot of providers think that they can hire a mid-level provider and let them see patients under their name since they are in the building. This is not the case and could cause problems when audited.

If a mid-level provider is seeing a new patient or an established patient for a new problem, it should be billed under the mid-level provider. For this reason, it is important to know all payor guidelines. Make sure your mid-level providers are credentialed with the groups contracted payers.

For more information on how Merem Healthcare Solutions can help your practice give us a call at 205-329-7514 or email us at info@meremhealth.com.