Incident to Billing in Healthcare: Navigating Complex Requirements and Ensuring Compliance

There are many rules that need to be followed in order to bill Medicare. One of the more complicated rules governs services that are provided “incident to” a physician’s care. Despite the complex requirements, there are advantages to billing incident to. Namely, non-physician practitioners are able to provide healthcare services and bill at the supervising physician rate.

However, billing incorrectly may result in fines and penalties on top of underlying overpayments. For example, a South Carolina urgent care provider agreed to pay $1 million to resolve claims that included alleged violations of incident to billing rules. Healthcare providers and suppliers must understand the complexities of these rules to help ensure compliance.

Listen as our authoritative panel of healthcare attorneys discusses the incident to billing requirements. The panel will also examine its advantages, as well as the relevant pitfalls and confusion, and the consequences of violations. The panel will offer guidance for compliance and defending against allegations of improper billing.

1. Requirements of billing services as “incident to”
2. Pros and cons of incident to billing
   1. Advantages
   2. Common pitfalls
   3. Associated confusion
   4. Potential ramifications
3. Guidance for compliance and defending against allegations of improper billing

The panel will review these and other key issues:

• What are the requirements for incident to billing?
• What are the best approaches for healthcare providers to ensure compliance when incident to billing?