Incident To (Part A)

“Incident to” service can only be performed in the office setting to qualify for Part B Medicare billing purposes.

• True

• False

Documentation must also support evidence that the supervisor was present and available. The documentation submitted to support billing “incident to” services must clearly link the services of the NPP/auxiliary staff to the services of the supervision physician. Evidence of the link may include:

• Co-signature or legible identify and credentials

• The initial visit establishing the link between the two providers

• Name and professional designation of the person rendering the service is legible for each service

• All of these

“Incident to” requires Direct Supervision. Direct supervision means the physician must be present in the office suite and immediately available and able to provide assistance and direction throughout the time the service is performed

• True

• False

“Incident to” billing does not apply to a

• New patient

• New problem for an established patient

• Both of these

The service must be integral although incidental. What does this statement mean?

• Physician must perform the initial service to establish the diagnosis and plan of treatment

• Follow-up services rendered must be connected to the course of treatment the physician planned at the initial service

• Both of these

The person supervising and person performing the service must be

• Employed by the same entity

• They may be an employee/leased employee

• Independent contractor

• All of these

Active Participation - It is expected that the physician performs subsequent services of a frequency that reflect that active participation of the course of treatment for the specific problem

• True

• False

Incident to is not

• Diagnostic tests covered under 1861 section 3 of the SSA are subject to their own coverage requirements

• Clinical lab tests (including a venipuncture) that are listed on the clinical lab fee schedule

• Preventive services have been enacted by several Medicare amendments and they have their own benefit category

• All of these

The physician is allowed to delegate to whomever he/she feels they have sufficiently trained. It would be beneficial for the physician to have written protocols for these situations.

• True

• False

The Professional Designation of the personnel that may render the services ordered by the Physician or NPP may be:

• Nurse practitioner (NP), Clinical nurse specialist (CNS), Physician assistant (PA), Certified nurse midwife (CNM)

• Auxiliary staff like a Medical assistant, licensed practical nurse (LPN), registered nurse (RN)

• All of these