Billing Incident-To

May 1, 2007

I hired a nurse practitioner for our practice with the intent of using her as an additional provider. I planned to have her credentialed. Another administrator said I was better off to bill her “incident-to” the supervising physician. Which is the more appropriate avenue? I am trying to partially offset the departure of a physician.

Question: I hired a nurse practitioner for our practice with the intent of using her as an additional provider. I planned to have her credentialed. Another administrator said I was better off to bill her “incident-to” the supervising physician. Which is the more appropriate avenue? I am trying to partially offset the departure of a physician.

Answer: It depends. First of all, “incident-to” is a Medicare-only concept. You’ll need to call or review the rules of all other payers to determine whether what I’m about to recommend applies to them as well.

By billing “incident-to,” the NP gets 100 percent of the provider fee schedule. Sounds great. But certain conditions must be met.

The NP can’t see new patients or even patients with new conditions. She’s limited to providing services incident to the physician’s or following a course of treatment the physician already established.

Also, a physician must be in the office suite while the NP is practicing. Finally, incident-to is an outpatient-only concept. It does not apply to anything done at the hospital.

If she bills under her own name, she makes 85 percent of the physicians’ fee schedule but can provide any services at any time, as long as they’re permitted by state license and supervision rules.