“Incident To” Rules Allow New Physicians to be Billed as "Incident To"

Tuesday, March 13, 2012

Many nonphysician providers work in family practices, including nurses, medical assistants, clinical nurse specialists, nurse practitioners, psychologists, respiratory therapists, physician assistants, physical therapists, social workers and laboratory technicians, among others. These nonphysician healthcare providers not only assist with patients, they often see patients in the physician’s absence. One way Medicare recognizes these individuals for payment purposes is by claims coding that allows reimbursing physicians for services provided “incident to” the physician’s care.

When Medicare was enacted, Congress recognized that physicians receive help in their offices and established incident to rules to cover services that are “an integral, although incidental, part of the physician’s personal professional services to the patient.” Because these services are so closely related to services provided by a physician, a claim for a nonphysician provider's services that are incident to the physician’s service can be submitted as if the physician performed the service. The nonphysician providers are invisible on the claims form (CMS Form 1500).

While it may be largely thought that incident to rules only apply to nonphysician providers, it is also true that a physician is allowed to bill incident-to another physician’s services as long as they meet the incident to regulations found in the applicable Federal Regulations authorizing billig for "incident to services," 42 C.F.R § 410.26.

This is important for physicians who are new to a practice. Under incident to rules, a new physician can see patients and the services can be billed incident to another physician’s services, prior to their effective date of enrollment or reassignment with Medicare. As with a nonphysician provider, the new physician wouldn’t be identified on the claim for services, and the supervising physician is held liable for all services. There may be important limitations on this, so one would be well-advised to consult with his or her health attorney billing and coding expert first. Additionally, the state's Medicaid Program may not allow this, even when Medicare and health insurers do allow it.

While this is not the typical case for incident to, the bottom line is it is allowed for a physician to directly supervise another physician and bill under the incident to rules when all the required conditions are met. Direct supervision is ordinarily defined as the supervising physician's being present in the building and available for consultation as needed. One cannot bill for incident to services if the supervising physician is not present in the same building.


Response to: “Incident To” Rules Allow New Physicians to be Billed as "Incident To"
Wednesday, September 5, 2012
Shakira says:

The HIPAA privacy rule elpnaixs this issue. Every time you see a doctor or a health plan company you are given a statement saying that you have received a copy of the HIPAA rules. If you are hurt on the job an employer has a right to your records. Otherwise no one that you do not authorize has a right to your records. Or your medical information. It is illegal for them to access your information without your authorization.

Response to: “Incident To” Rules Allow New Physicians to be Billed as "Incident To"
Monday, January 14, 2019
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