August 18, 2021

Incident-to Billing? Here Are Your Tips!

Incident-to billing is a service performed by a non-physician provider under the supervision of a physician. More and more practices employ Nurse Practitioners to handle additional volume.

When a non-physician provider performs a service, it gets confusing if the service is incident-to billing or not, whether to bill under the physician or non-physician? 

Know these basic rules for performing incident-to billing under a Physician:

  1. Can be used only in a non-institutional facility (typical office setting).
  2. The physician has to provide the patient's initial visit.
  3. Typically used in follow-up care.
  4. NP has to be employed by the group.
  5. Active participation of the provider in follow-up and treatment - specifically when the patient's condition changes.
  6. Both physician and non-physician providers must belong to the same facility.
  7. Record who performed the service and that the physician or a group physician was in office at the time of the service.

The key benefit of incident-to billing is, that billing under Physician is reimbursed at 100% of the contracted rate while billing under NPPs gets reimbursed at 80-85%.

Learn the billing rules detailed by AAFP's article that also lists the additional considerations here:

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