Billing New Physicians Incident-to Current Physicians

June 11, 2014

When it comes to billing Medicare, you may very well be able to bill one physician incident-to another. Here's how.

A common question that arises in many medical practices that hire a new physician is whether the new physician can be billed incident-to one of the practice's current physicians until the necessary credentialing can be completed.  For every payer the rules are different, so it’s not always a simple answer to figure out how best to handle this situation for your practice.  However, when it comes to billing Medicare, you may very well be able to bill one physician incident-to another.

As most practices are aware, using “incident-to billing” is a common way to bill Medicare for nonphysician providers, such as a nurse, medical assistant, or physician assistant. Medicare allows practice physicians to be reimbursed for the services provided by these individuals when the services are integral to the care provided by the physician and other requirements are satisfied (see 42 C.F.R § 410.26).   When billing services incident-to, the nonphysician providers are not listed on the billing record as having rendered services, so it appears as though all services were rendered by the physician.

These same incident-to rules for nonphysician providers apply to billing incident-to for physician providers.  However, there are some issues of which physicians should be aware:

• Because the “new” physician is not identified on the claim for services, the supervising physician is held liable for all services.  This means if there is a malpractice claim involving the new physician, medical records will reflect the services as having been provided by the supervising physician, making him more vulnerable to malpractice exposure.

• The supervision requirements don’t always work well for physicians who operate independently at multiple sites and/or different hours of the day.  It is essential to follow the rules closely.  A supervising physician should be present in the suite and immediately available in order to be able to bill another physician’s services incident-to. Additionally, the performing physician cannot change anything in the billing physician’s plan of care.

• If physicians are being compensated based on production, it can be very complicated to properly credit the correct physician for her services. 

• Be careful of the requirements of other payers.  Not every payer follows Medicare, and incident-to billing may be considered a violation of your contract with other payers.

Although incident-to billing can be a helpful way to bill for a new physician, it should be used sparingly and briefly.  It is always preferable to properly credential physicians in advance of providing services to a new practice.