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“Incident to” versus Independent Billing Presented By Jennifer Smith, RMC January 29, 2007 “Incident to” Is a service rendered by a Non- Physician Provider (NPP), in which the services rendered are within the physicians plan of care. These services should be billed under the physicians provider # with the NPP listed as the auxiliary doctor. Incident to Billing Medicare, Medicaid and BCBS are the only insurance plans that currently have NPP policies established. These are the 3 insurances that will be billed based on the service rendered. All other insurance plans can be billed as an incident to service regardless of the service rendered. Example of an Incident to service Pt is seen by Dr Kutsche and is diagnosed with a severe UTI. The physician states that if there are no relief in the patient’s symptoms to return to the office in 4 days. The patient calls the office in 5 days and states that she is not feeling any better and needs to be seen. The office staff makes an appointment with the NPP (JoJean Hamilton) in the office. The patient is seen by JoJean, when the patient checks out the service will be billed with the supervising physician’s number and JoJean’s number as the aux Dr. The reason that this service is considered incident to is because the physician has already established a plan of care for this patient’s problem. Independent Service Is a service rendered by a NPP that has not be established in a physician’s plan of care for the patient. These services will be billed under the NPP’s provider numbers. Independent Billing Medicare, Medicaid and BCBS are the only insurance plans that currently have NPP policies established. These are the 3 insurances that will be billed based on the service rendered. All other insurance plans can be billed as an incident to service regardless of the service rendered. Example of an Independent Service A new patient presents to the office for a yeast infection. The patient sees JoJean Hamilton. This service is considered an Independent service because there is not plan of care established by a physician from this office. This service would be billed under JoJean’s physician number which is 7859. Incident To/Independent Incident To Independent Billed under supervising physician’s Billed under the NPP’s number –7859. provider number There will be no auxiliary Dr added to the claim. A supervising physician must be able to be reached at all times Please note that the only insurances while services are being that can be billed independently is rendered. Medicare, Medicaid and BCBS. Also The auxiliary Dr may need to be please note that the East China added if not already there and office will split bill these services that number will be HAMI. and the technical portion for Medicare should not be billed. The group for this service will be More information to follow regarding what ever location the service is using the proper group and facility. being rendered.