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Mar 12

Medicare says a physician MAY bill incident to another physician’s services

This is big news! My friend and colleague David Zetter (www.zetter.com) has been in discussions with CMS in Baltimore about this issue. He recently posted the following email to the NSCHBC listserv (www.nschbc.org):

Hello Everyone-

I thought I would share some information with you that I found out today from CMS in Baltimore via a phone conversation and documented in an email. I know that this will take some of you by surprise, because it did me.

A physician MAY bill incident to another physician’s services as long as they meet the “incident to” regulations found in 42 CFR Ch IV § 410.26. This comes straight from the person’s mouth that wrote the regulations at CMS.

What makes this significant is that a new physician to a practice may see patients and bill incident to another physician’s services prior to their effective date of enrollment or reassignment with Medicare. The new physician would bill via the supervising physician’s NPI as the rendering provider. The new physician wouldn’t be identified on the claim for services at all, BUT the supervising physician WOULD be held liable for all services and SHOULD sign off on all service notes and reports for the patients seen. This would be our recommendation to our clients.

Mr. Zetter,

I wanted to respond to your questions directly. I work in the Division of Practitioner Services on incident to payment policy.

I understand your concerns. There are situations where a physician billing for another physician could be used to hide unethical practices. While it is true that we do not specifically name physicians as auxiliary personnel for the purposes of incident to, we also do not name any type of medical professional as auxiliary personnel in the definition. We also do not require that the auxiliary personnel be a lower level professional. The definition is broad enough to include physicians and many other types of health care providers and staff. We also stated in the preamble text of the CY 2002 Physician Fee Schedule final rule with comment period that, “We deliberately used the term any individual so that the physician (or other practitioner), under his or her discretion and license, may use the service of anyone ranging from another physician to a medical assistant.” While I do not think it is the typical case for incident to, it is not prohibited for a physician to directly supervise another physician and bill under the incident to provision when all the required conditions are met.

Please contact me if you have any follow up questions or concerns.

Best regards,
Erin
Centers for Medicare and Medicaid Services

Best regards,

DJZ

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →