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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.

				
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posted:11/1/2012
language:English
pages:8