I was doing some research and thought I would share this with you. It is not a well-known requirement or at least one some administrators and physicians like to ignore….
The use of mid-level providers is common in most clinics these days and practices may choose one of three mid-level billing options offered by Medicare and some Medicaid services (Pollock, 2010):
(c) Split billing.
Direct billing to Part B may occur after an office visit and/or procedure with a mid-level and does not require direct physician supervision. Under direct billing, there are no restrictions or exclusions for “new” patients and the mid-level will bill using their own NPI numbers; the downside, payment is typically 85% of the physician fee schedule.
The “incident-to” billing option allows 100% of the physician fee schedule to be reimbursed for mid-level services, but these service MUST be performed under the direct (not general) supervision of the physician; the claim is submitted under the physician’s NPI number. Direct supervision means the physician must be located in the same physical office as the mid-level at the time services are performed (Lowe, 2008). This is to one requirement that many physicians are non-compliant. In addition, new patients (and in some states each new problem) must first be seen and assessed by a physician prior to the mid-level taking over the care of the patient. I would also suggest carefully reviewing the mid-levels documentation and co-signing any orders and progress notes to document the direct supervision requirement was met. Some audits determined a lack of a supervising physician’s signature on the documentation among other requirements:
For “Incident To” services, the medical record must document:
- Services must be provided by office personnel whom the physician directly supervises and who represents a direct financial expense.
- Physician review of the qualified practitioner’s chart notes in order to monitor treatment progress.
- Physician signature indicating the physician is actively involved in the patient’s course of treatment.
- Physician must be present in the office suite.
- Solo practitioners must directly supervise the care.
- In group practices, any physician of the group may provide direct supervision (“Medical review,”para. 3).
Split billing can be used when permitted by state requirements. Make sure your organization’s policies and procedures reflect these important requirements.
Lowe, M. (2008). Incident-to billing of non-physician practitioners: How physicians
can avoid small mistakes that could paralyze their practice.