Understanding the Medicare “Incident To” Rules
By Staff Reporters
Under the “incident to” rules, Medicare Part B pays for some services that are billed by physicians, but performed by non-physicians. And, the Department of Health and Human Services [DHHS] and Office of Inspector General [OIG] says that some of these services might be used improperly.
Suggestions to CMS
The agency recommends the Centers for Medicare & Medicaid Services [CMS] perform the following:
- Revise the “incident to” rule to require that physicians who bill Medicare, but don’t perform the services themselves, ensure that the services are provided by a licensed physician, or a non-physician with the necessary training, certification or licensure.
- Require that physicians who use non-physician services identify this with a service code modifier on bills.
- Take appropriate action to detect when physicians bill for “incident to” services that are not covered under the rule.
Assessment
In the current healthcare reform environment, Medicare services by non-physicians are coming under increased scrutiny. And, the OIG is finding that the “incident to” rule is allowing medical care to be provided by non-physicians who may lack the necessary qualifications. This may be a healthcare financial, insurance and quality breach. So, don’t let this trap “bite” you.
Source: HHS Office of Inspector General (www.oig.hhs.gov/oei/reports/oei-09-06-00430.pdf)
Conclusion
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Filed under: Health Insurance, Health Law & Policy, Healthcare Finance, Research & Development | Tagged: "incident to" rules, Centers for Medicare & Medicaid Services, CMS, Department of Health and Human Services, DHHS, HHS, medicare, Medicare Part B, non-physician providers, Office of Inspector General, OIG | Leave a comment »