Home Forums Discussions General Discussion Incident To Medicare Billing

So, I have a new PA just approved by Medicare. I'm aware of the rules for "incident to" billing, but I'm wondering if anyone has done this and your perspective on if it is worthwhile.

For the uninitiated, Medicare will pay your PA 100% instead of the usual discount if you follow certain rules: the visit
Must relate to a service initially performed by the physician. Must be performed under direct supervision – when the physician is in the office suite/building. Cannot be billed when more than 50 percent of the visit is for counseling or care coordination. May not include diagnostic testing.

We used to be able to bill NP's and PA's as "incident to" but a few years ago Medicare stopped that -- they now have their own Medicare and NPI numbers, and they have to bill for themselves (at 80% of MD rate.)

Incident to medicare billing still alive under certain conditions.

Supervised on stie, management of chronic condition plan set forth by MD.

One might do acute visits by covering 1 chronic condition during the visit and not billing based on the acute cold/bronchitis.

What's everyone's experience billing incident-to with commercial insurers?

I'm interested in hearing more! I don't think missing a level 4 because of unbilled complaints would be worth it, but interesting idea!

Well I'm not advising anything, simply relating what a colleague has done. Read the incident to regulations. Follow them.

There is nothing saying you can't do acute care and not bill for it. The regs simply say what can be billed incident to.

If your NP saw a simple acute bronchitis it was probably 99213 anyway.
NP also spent a few minutes on a chronic condition (plan established by MD) enough for a 99213 (pretty easy), then bill for the chronic condition f/u 99213 incident-to and don't bill on acute part.

Or you are saying then the combination (acute + stable chronic f/u) was probably a 99214. Bill NP independent at 85% of 99214 rate? Then you have to justify/document the 99214 and increased audit risk. Maybe 100% of 99213 is easier and faster?