Medicare “Incident To” Services Under Continued Scrutiny

According to the Office of Inspector General (“OIG”) 2009 Work Plan, “incident to” services continue to be an area of scrutiny. The OIG is currently reviewing this billing area and expects to issue a report of its findings in 2009.

In summary, in order to bill “incident to” services, the services must be integral to the physician’s service, performed by a person who is paid by the physician and who is under the direct supervision of the physician. The services must also be performed in a non-institutional setting. Direct supervision requires that the physician be on the premises in the “office suite” while the services are being performed. It is not appropriate to bill “incident to” services on a first patient visit as the physician must initiate a course of treatment during which the incident to services are performed. It is also important to keep in mind that the physician must be actively involved in the patient’s treatment course and thus the physician’s involvement in subsequent visits should be documented. For those physicians utilizing the “incident to” billing rules, it is important to establish careful documentation practices to support fulfillment of the requirements. Depending on the circumstances (e.g., type of ancillary provider), other billing options may be available if the practice is unable to meet the “incident to” requirements. For example, if a nurse practitioner is performing the service, this may include the submission of a claim under the provider number of the nurse practitioner.

A qualified healthcare attorney can assist your entity to adopt and implement effective billing compliance policies and procedure. For more information, please call Abby Pendleton, Esq., Robert Iwrey, Esq., Adrienne Dresevic, Esq., Carey F. Kalmowitz, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510, visit The HLP website’s Stark and Anti-Kickback page, or visit The HLP website.