Incident-to: Two Applications to One Concept

Simplify complex compliance rules for clinical and ancillary staff billing

Incident to is a concept that Medicare rules define for an incidental though integral service. This service is performed by auxiliary, clinical and ancillary staff. Definitions of each of these staff types change what types of services can be performed incident to.  State licensing is also a part of what individuals are “allowed” to do under this concept that allows billing of the service to be done under the supervising provider. It gets confusing when you have incident to services performed by a Medical Assistant under supervision of a Nurse Practitioner or Physician’s Assistant and can also have services performed by the same Nurse Practitioner or Physician’s assistant under supervision of a physician. 

Services as uncomplicated as an immunization can be billed incident to with ancillary staff performing the task. Other commonplace services in the office that are delegated to clinical staff can be things like most of an Annual Wellness visit or an ear irrigation.  Even a low level Evaluation and Management (E&M) service such as a 99211 can be performed by the clinical staff under a plan of care determined by a billing provider if guidelines are met.

It is when those services become more complex like E&M services, above the level one, that things can get more confusing.  Some may think it more complex, but the concept of an incidental though integral service still apply.

Webinar Objectives

• Understanding the concept of incident to is imperative as the first step in identifying and properly documenting services that will be billed under a provider and not the office staff. 
• Understanding the definitions of the differing types of staff is another step in the process to see what limitations the CPT codes may place on who can perform what under the incident to concept
• Lastly, understanding the concepts of supervision is important.  Not only supervision as far as who needs to be in the office or where but also supervision from a claims perspective.  Whose name goes in which box and why is an important step in compliant billing.

Webinar Agenda

• What are the differences between auxiliary and ancillary staff?
• What is the definition of clinical staff?
• Can these three types of staff all perform the same services?
•  Incident to services and Non-Physician Practitioners (NPP’s) Medicare’s definitions
• Claims – what goes where?

Webinar Highlights

• Definition of clinical staff - Where to find it
• Definition of auxiliary and ancillary staff
• Incident to services defined
• Who needs to be where?
• Payment issues
• Common errors and misconceptions with incident to services

Who Should Attend

Coders, Billers, Office Managers, Office Administrators, Nurse Practitioners, Physician Assistants, Physicians