Medical Billing Blogs

Using non-physician practitioners (nurse practitioners, physician assistants, clinical nurse specialists, and so on) to boost productivity in a medical practice is an effective strategy to do so. However, covered services delivered by non-physician practitioners (NPPs )   are reimbursed at a lower rate (85% of the fee schedule amount) under Medicare rules. The “incident-to” billing for services rules provide an exception, enabling 100 percent reimbursement for non-physician treatments that meet the guidelines outlined in Chapter 15, Section 60 of the   Medicare Benefit Policy Manual . The term “incident to” a physician’s professional services denotes that the services or supplies are provided as an integral, although incidental, element of the physician’s professional assistance during the diagnosis or treatment of an accident or sickness. However, the ability to use “incident to” charging is subject to several constraints and limits. Let’s have a look at such complexities: Co...

  MGMA has reported that many physician-owned multi-specialty practices and groups often use non-physician providers (NPPs). According to the report, the reason is that the NPPs with the practices often generate higher income than physicians and are financially more viable. NPPs, however, need to function directly under the supervision of a physician to provide billable medical services. Therefore, registered nurse aestheticians, surgeons, or physicians' assistants can be included in the facility under the NPPs. Further under the Medicare fee schedule, the NPPs' medical practices can receive full payment and reimburse the amount for the services successfully by reporting the NPSS services under 'incident-to' for physician care. But CMS has implemented strict and complex guidelines for incident-to billing. That’s why physicians must understand the rules of the medical billing procedures correctly to receive full payment from the insurers for the services rendered ...