Incident to

Incident to is a term commonly used in healthcare revenue cycle management (RCM) that refers to a billing practice where services provided by non-physician healthcare professionals are billed under the name of a supervising physician. This practice allows for the reimbursement of services provided by non-physician practitioners at the same rate as if they were provided directly by the physician.

The concept of "incident to" is based on the assumption that the services provided by non-physician practitioners are an integral part of the physician's professional service. Therefore, when these services are billed under the physician's name, they are considered to be "incident to" the physician's service.

While incident to billing and split/shared billing are similar concepts, there are some key differences between the two.

Incident to billing refers to the billing of services provided by non-physician practitioners under the name of a supervising physician. The services are typically provided in the physician's office or clinic, and the physician must be present in the office suite during the time the services are rendered. The reimbursement for incident to services is typically at the same rate as if the physician had provided the services directly.

On the other hand, split/shared billing refers to the billing of services provided jointly by a physician and a non-physician practitioner. In split/shared billing, both the physician and the non-physician practitioner must be present during the time the services are rendered. The reimbursement for split/shared services is typically divided between the physician and the non-physician practitioner based on their respective contributions to the service.

In summary, incident to billing involves billing services provided by non-physician practitioners under the name of a supervising physician, while split/shared billing involves billing services provided jointly by a physician and a non-physician practitioner.

To better understand the concept of incident to billing, let's consider a few examples:

Example 1: A nurse practitioner (NP) is working in a physician's office. The NP sees a patient for a routine follow-up visit and provides a medication refill. The physician is present in the office suite but does not see the patient. In this case, the services provided by the NP can be billed incident to the physician's services, and the reimbursement will be at the physician's rate.

Example 2: A physician assistant (PA) is working in a hospital setting. The PA sees a patient in the emergency department and performs a minor procedure under the supervision of a physician. The physician is present in the same department but does not directly participate in the procedure. In this case, the services provided by the PA can be billed incident to the physician's services, and the reimbursement will be at the physician's rate.

Example 3: A nurse practitioner is working in a rural health clinic. The nurse practitioner sees a patient for a routine check-up and provides a prescription refill. The physician is not present in the office suite during the time the services are rendered. In this case, the services provided by the nurse practitioner cannot be billed incident to the physician's services, and the reimbursement will be at the nurse practitioner's rate.

These examples illustrate how incident to billing can be applied in different healthcare settings. It is important to note that incident to billing is subject to specific rules and regulations set forth by Medicare and other payers. Healthcare organizations should ensure compliance with these guidelines to avoid potential billing errors or fraud.

In healthcare revenue cycle management, understanding the concept of incident to billing is crucial for accurate and compliant reimbursement. Incident to billing allows for the billing of services provided by non-physician practitioners under the name of a supervising physician, with reimbursement at the physician's rate. It is important to differentiate incident to billing from split/shared billing, as they involve different scenarios and reimbursement methodologies. By following the appropriate guidelines and regulations, healthcare organizations can ensure proper billing practices and optimize their revenue cycle management processes.