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Incident To
- Does not apply in hospital
- Must be expense to physician or group
- Requires direct over-the-shoulder physician supervision (Dr
In Suite)
- Cannot See New Patients
- Cannot diagnose/treat new problem
- Physician initiates treatment plan
- Physician actively in ongoing care
- Bill any level (if NP, PA, CNS)
- Bill under physician’s name and PIN
- No reduction in payment
Incident
To |
Own
PIN |
No New Patients |
Any Patient |
No New Problems |
Any Problem |
Physician
In Suite |
Who cares
where Dr is? |
Not at Hospital |
Any Place
of Service |
Physician
Directs Patient Care |
NPP Direct
Patient Care |
Full Payment |
85% of Physician
Fee |
Code at Any
Level |
Code Any Level |
Factors to Consider:
- Even if an NP’s service is non-billable,
is the NP saving the physician time so he can do other billable
services?
- Is patient care and satisfaction enhanced by the service?
- Can more patients be seen as a result of the team effort?
- Is income increased by efficiency?
- Is there a reduction in adverse events?
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