Key Components of “Incident To” Billing

Key Components of “Incident To” Billing

Incident-to billing is a way of billing outpatient services (rendered in a physician’s office located in a separate office or in an institution, or in a patient’s home) provided by a non-physician practitioner (NPP) such as a nurse practitioner (NP), physician assistant (PA), or other non-physician provider. 

OLYMPUS DIGITAL CAMERA
Dentist collaborating with IBCLC

*Physician must be onsite (some interpret this as being present during part of exam).
*The supervising physician need not be the physician who performed the initial service.
*Physician must be in-network with said insurance company.
Insurance company must accept incident to billing.
*Patient must have established care with physician. 
*The NPP must be employee or contractor of physician.

*If there is change of diagnosis, physician must step in to initiate new plan.
Dentists can bill using medical codes for certain procedures, including frenotomies.

All of the above requirements leave a lot of room for physician judgement in terms of how they institute policies.

Some references:

Medical Economics
Medicare Learning Network