Fines, Penalties, Recoupments Under Incident-To Services

By Shannon DeConda, CPC, CPC-I, CPMA, CEMC, CMSCS | June 5, 2014

Many physician practices insist on using incident-to billing for services rendered by non-physician providers (NPPs) in order to avoid the 15 percent reduction of Medicare’s allowed amount (though often they know little about the required guidelines).

Incident-to billing brings with it confusion to practice operations, risks and liabilities associated with audits, as well as a hidden negative financial impact. Incident-to guidelines include specific guidance on what services may be billed under these provisions, plus information on reimbursement issues, carrier allowance variations, scheduling issues, and the controversy over which providers are permitted to bill incident-to.

Remember that “incident-to” is a term that relates mostly to Medicare services. Most other payers choose not to follow the same protocols when NPP services are reported.

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