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Take heed of 'incident to' rule for medicare. (Whose Provider Number is it, Anyway?).
WASHINGTON -- Be careful of the "incident to" rule when billing Medicare for services performed by nonphysicians, Alice Gosfield warned at a meeting sponsored by the American Health Lawyers Association.
The "incident to" rule has become more complicated with the advent of more degreed professionals in the doctor's office, said Ms. Gosfield, a health care attorney in Philadelphia. "The [doctor] used to have 'the girl.' She was either a high school graduate, laboratory technician, medical transcriptionist, a nurse, or the doctor's wife. [She] ran the physician's office and did everything--scheduling, took blood, took EGGs."
Because this was the situation when Congress was creating the Medicare program, Medicare pays for everything "that [is] an incidental although integral part of the physician's personal, professional service to the patient," Ms. Gosfield commented. "If Medicare had only paid for [services provided by the physician], medical practice would have come to a grinding halt."
But in physician offices today, there are "all kinds of people, some of whom have special training and some of whom do not have special training," she said at the meeting, which was also sponsored by the Health Care Compliance Association. "Some of them, Medicare recognizes as able to get their own [provider] numbers and some are just 'incident to'" the physician service and they can be billed under the physician's provider number.
The rules for "incident to" billing are stringent, Ms. Gosfield said.
First, there must have been another service performed to which the billed-for services are "incidental," meaning the physician must have seen the patient previously.
Also, the physician must be immediately ...
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Source: HighBeam Research, Take heed of 'incident to' rule for medicare. (Whose Provider Number...