Many practices are moving over to hiring midlevel providers such as Nurse Practitioners and Physician Assistants instead of physicians to treat patients. When billing for such providers, if billed under their own NPI number, physician owners, hospitals, and groups can expect only 85% reimbursement of the physician fee schedule for the particular service rendered. In many cases since the midlevel provider is acting independently that is the most efficient and appropriate way to bill for the services rendered. However, there are times when a supervising physician, either an MD or DO, is an integral part of the patient’s work up and treatment and this physician’s time must be accounted for. In these incidences the visit may have been primarily performed by the mid-level provider but may be billed incident to the supervising physician and thus garner 100% reimbursement. Understanding the rules in regards to when it is appropriate to bill incident to and when it is not, is key to proper reimbursement and compliance. Also knowing the nuances between various payers, including Medicare, is also key.
Areas Covered In The Session:
- Overview of Incident to Billing
- Appropriate Time to Bill and when it is not.
- Required Information to be documented in medical record
- Medicare’s Incident To Billing Guidelines
- other Payers Incident to Billing Guidelines
- What is incident to and when does it
- Who may bill incident to – and who
- When is it appropriate to bill incident to and what must be documented in the medical
- Understanding Medicare’s Incident To Billing Guidelines to ensure
- Understanding other Payers Incident to Billing Guidelines to ensure
- Practice Managers
- Office Managers
- Medical Billers
- Medical Coders
- Nurse Practitioners
- Physician Assistants
- Clinical Documentation Improvement Specialists
- MR Auditors
- Front Desk
Dreama Sloan-Kelly, MD, CCS has over 16 years of experience in the medical field. A graduate of Wellesley College and Tufts University School of Medicine she has a varied background including clinical, billing, and coding. Dreama is President/CEO of Kelly, Sloan, and Associates, LLC and speaks at various seminars and webinars, imparting her knowledge in an upbeat, matter of fact, manner. Her goal is get the pertinent information to the attendee, minimize the nonsense, and make sure everyone has fun at the same time. Dreama works with practices one on one, through coding consulting. She offers in-services seminars that can be held on or off-site. Dreama has learned in most seminars you spend a whole day only getting 20% of what you need, and 80% you leave – she has made it her goal to carve out the 20% that you need and giving you the take home message that will help you and your practice.