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There’s a very restrictive framework of guidelines built by the Centers for Medicare and Medicaid Services (CMS) around reimbursement via ‘incident to’ reporting. 

When “billing ‘incident to’ the physician, the physician must initiate treatment and see the patient at a frequency that reflects his/her active involvement in the patient’s case. This includes both new patients and established patients being seen for new problems. The claims are then billed under the physician’s NPI.”

A core issue relevant to NPPs must always revolve around applying their healthcare practitioner skillset to best advantage. But what’s the optimal way to effectively empower your NPP’s healthcare provider expertise while still leveraging the NPP’s role as revenue generator? And how can achieving those goals be accomplished to the practice’s gain but still soundly within federal compliance?

Nowadays, federal healthcare dollars are guarded by a maze of sharp-edged compliance rules and regulations. While “it takes a village” to appropriately utilize and bill for NPPs in the office involving receptionists, coders/billers, and the practice administrator, it must start with the providers themselves. They must be responsible for knowing—to an operational degree—the CMS guidelines. Providers should know CMS guidelines? Yes, it’s critical that both the physicians as well as each practice NPP know the guidelines that allow the freedom to evaluate and treat Medicare patients, as well as get paid for services in numerous and ever-changing daily scenarios.

So now is the perfect time for you and your team to arm yourselves with knowledge. And you can do so when you download a series of educational webcasts for you to share with your team.


Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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