Incident To Billing vs. Shared Visit Billing

[JohnFerguson]

Can anyone give some good insight into incident to vs. shared visit billing?

[jdenning]

This is how I do it. If I am seeing a patient for follow up and am "following the plan outlined by the physician" AND the physician is physically present in the office, I can bill that visit "incident to." I can also bill the visit "incident to" if the physician comes in briefly for a review of plan. If I see the patient on my own without physician present on site then I can't bill incident to. If I see the patient on my own and add a new problem to the problem list, then I can't bill that visit as "incident to" since I'm not following the physician plan whether the physician is physically present or not.

[coloradopa]

This is how I do it. If I am seeing a patient for follow up and am "following the plan outlined by the physician" AND the physician is physically present in the office, I can bill that visit "incident to." I can also bill the visit "incident to" if the physician comes in briefly for a review of plan. If I see the patient on my own without physician present on site then I can't bill incident to. If I see the patient on my own and add a new problem to the problem list, then I can't bill that visit as "incident to" since I'm not following the physician plan whether the physician is physically present or not.

This is a good answer to incident to. For shared billing its only available on the inpatient side. In the shared billing model the PA sees the patient and writes a note. The physician then sees the patient and documents one of the three mandatory parts of the note (HPI, PE or A/P). The bill is then submitted under the physician at 100%. The key is the physician has to physically see the patient and has to document one element of the encounter.

[physasst]

This is a good answer to incident to. For shared billing its only available on the inpatient side. In the shared billing model the PA sees the patient and writes a note. The physician then sees the patient and documents one of the three mandatory parts of the note (HPI, PE or A/P). The bill is then submitted under the physician at 100%. The key is the physician has to physically see the patient and has to document one element of the encounter.

 

People can get into a lot of trouble with incident to billing because there are a lot of rather strict requirements to meet. My advice is just to bill independently when you see the patient on your own, and have the physician bill if they saw the patient.

 

A lot of Medicare audits of PA billing revolve around incident to billing..because of that, we just don't even bother with it. Too much of a PITA.

[Guest Paula]

People can get into a lot of trouble with incident to billing because there are a lot of rather strict requirements to meet. My advice is just to bill independently when you see the patient on your own, and have the physician bill if they saw the patient.

 

A lot of Medicare audits of PA billing revolve around incident to billing..because of that, we just don't even bother with it. Too much of a PITA.

 

I agree with physst. In my practice I have never had a discussion whether I am "following the plan of the physician". This terminology has always confused me. How would CMS know there is a plan from a physician? Why would you not be following your own plan for your patient? I'm in rural care. Most of the time I'm making my own treatment plans for patients, see new patients, and the doc doesn't see many of my patients. We don't use incident to billing.

[jmj11]

People can get into a lot of trouble with incident to billing because there are a lot of rather strict requirements to meet. My advice is just to bill independently when you see the patient on your own, and have the physician bill if they saw the patient.

 

A lot of Medicare audits of PA billing revolve around incident to billing..because of that, we just don't even bother with it. Too much of a PITA.

I totally agree . . . it is not worth the 15-20%. I tried it here for a while because of another reason, our EHR incentive payments were ONLY based on what the physician produced, even though I had to also meet the attestations. So, we tried to bill incident to as much as we could because I see 97% of the patients and that way I thought we could boost our physician productivity. However, it was impossible to meet all the criteria and when I did on a few occasions . . . the biller was so confused about it that I was afraid she would make a mistake and bill incorrectly. The U of Washington had a huge suit over this a few years ago as it pertained to residents who billed incident to the attending but for whom the attending didn't meet the criteria of incident to.