'Incident To' Explained

January 2018

Incident To Cover

"Incident to" refers to professional services that are provided by a non-physician (e.g. advanced practice registered nurses, physician assistants, or psychologists), but are billed by a physician supervising the services as if the physician provided the service in its entirety – in other words, the services were provided incident to the physician’s own provision of care.

Why is Incident To Important?

As the health care delivery system evolves and patient demand increases across all types of practices and specialties, it is becoming increasingly common for physicians to work alongside other health care professionals as part of a health care team. Office-based practices and other types of health care facilities are hiring advanced practice registered nurses (APRNs), physician assistants, psychologists and others to provide services to patients under the clinical leadership of a physician.

Medicare allows certain types of non-physician practitioners to be credentialed and bill for services directly. The fee schedule for these practitioners is generally 85 percent of the Medicare physician fee schedule. However, in certain circumstances, incident to billing enables a practice to receive full reimbursement (i.e. 100 percent of his/her fee schedule) for services provided by a non-physician.

While incident to billing can increase your practice's bottom line, it's essential to keep in mind that there are rules and regulations that must be followed to avoid a potential audit and recoupment by both private and public payers for claims that don’t necessarily qualify as incident to.

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