What to know about coding, clinicians, compliance: Incident-to billing in mental health

Physicians who oversee clinicians working in mental health practices are helping patients, but with billing and coding complexities, they may run the risk of noncompliance. Getting incident-to billing right isn't just a nice-to-have. It's a must for keeping your practice afloat.

What is the situation like? Optum and UnitedHealthcare are rolling out these "risk matrices" to spot practices that might trip up on incident-to — think of it as a red-flag system for audits. The U.S. Centers for Medicare & Medicaid Services have improper incident-to payments squarely in their crosshairs for 2025 reviews, which means one sloppy claim could cost you big. We're talking denials that stack up fast, headaches during credentialing renewals, and those dreaded clawbacks that hit months later.

In mental health, where demand is skyrocketing but staffing is tight, it is not an option to skip the basics on supervision or documentation. Get ahead of it, and you'll protect your revenue while scaling up.