3 ways to avoid denials due to unmet 'incident to' billing requirements

Joette Derricks, a Baltimore-based healthcare compliance and revenue integrity consultant, shared three  tips with Medical Economics on how to prevent claim denials due to unmet "incident to" billing requirements.

Incident to billing permits nonphysician practitioners to bill certain services using the physician's CMS-issued unique 10-digit identification number, known as a national provider identifier. But Ms. Derricks notes that unmet incident to billing requirements can lead to claim denials for reasons such as services being billed for a new patient, or services being billed for a new issue with an established patient.

Her strategies for avoiding these denials are:

1. Ensure that a new patient's first appointment is with a physician who can initiate a care plan.

2. Ensure an established patient with a new issue discusses the new issue with the supervising physician and that the physician initiates a care plan for the new issue.

3. Use the nonphysician provider's national provider identification number, if a physician is not available to assess an established patient's new problem and the nonphysician provider is credentialed with the insurer.


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