One billing concept that is linked to a lot of confusion is incident-to reporting of services performed by clinical staff or qualified health care professionals (QHPs). In short, incident-to billing allows a physician or QHP (eg, nurse practitioner [NP], physician assistant) to bill for supplies and services provided incidental to a physician’s or QHP’s personally performed services. This concept was introduced by Medicare and is used by many payers, including some Medicaid plans. Incident-to billing comprises 3 main categories.

Incident-to services performed by QHPs but billed by a supervising physician may result in higher payment than would be received if the QHP billed directly for the services (eg, Medicare pays 85% of the physician payment for services billed by a QHP).

While physician billing for supplies and medications integral to a service is reasonably straightforward, the other 2 categories are subject to rules that may vary by circumstances such as...

You do not currently have access to this content.