The Five Most Common but Fatal Incident-to Mistakes - DoctorsManagement The Five Most Common but Fatal Incident-to Mistakes - DoctorsManagement

The Five Most Common but Fatal Incident-to Mistakes

Incident-to and split/shared services allow practices that employ non-physician providers (NPP) such as physician assistants and nurse practitioners to multiply revenue and patient satisfaction – but only if you can follow the complex set of billing rules.

Here are five common mistakes that cause financial problems for practices that bill for incident-to and split/shared services when auditors come knocking:

  1. A patient being seen under an established plan presents a new, unrelated problem. This service gets billed by the NPP as part of the incidental care – but it can’t be because the physician never saw the patient for this problem.
  2. No supervision is a surprisingly common error. Direct supervision is required for incident-to, which means the doctor needs to be nearby in the same suite. It does not mean “available by phone or email.”
  3. For a split/shared visit, trying to bill under the physician’s name when only the non-physician saw the patient face-to-face. Both the physician and non-physician must see the patient for split/shared.
  4. Not enough documentation is among the biggest problems for any service, let alone for a split/shared service. Often physicians write “reviewed NPP findings and agree” and bill the service as split/shared. The note needs to show what work was personally done by the physician.
  5. Forgetting payer-specific modifiers is guaranteed to result in overpayment demands after an audit. For example, Aetna requires the SA modifier to be appended to all split/shared services.

Used correctly, incident-to and split/shared service are incredibly useful billing rules for any practice that employs non-physician providers such as nurse practitioners and physician assistants. If ignored, however, your practice might be at an increased risk of audit exposure or may be missing revenue opportunities.

If you have questions about these or other billing and coding rules, contact us via email or call 800-635-4040.

Check out our eBook and webinar package, Everything You Need to Know About Incident-to and Split/Shared Services. This product can help you increase revenue and physician productivity, improve office and inpatient effectiveness and decrease your risk of audits. Use the webinar, decision tree, quick-reference cards, and 10-scenario quiz to train yourself, your staff and your providers!