A Comprehensive Guide to Incident-to Billing in Medical Practices

If you are a non-physician practitioner (NPP) getting only 85% revenue for your services, then there is good news for you!  

With incident-to billing, you can get 100% revenue for rendered services even as an NPP.   

All you need to do is understand billing guidelines and ensure you utilize the knowledge to maximize revenue and boost your bottom line. Whether you are a full-time NPP, or your practice uses incident-to billing, you can take your revenue cycle management to the next level.   

This blog is your complete incident-to-billing guide with information about streamlining the process and achieving timely reimbursement.   

Let’s get straight to the basics and start exploring the concept!  

Let’s Define Incident-to Billing   

When nurses and medical assistants (non-physician practitioners) get paid for a medical service in a way as if the healthcare provider rendered the services, it comes under incident-to-billing.   

Considering the medical assistance is given under the healthcare provider’s supervision and within the regulatory guidelines, NPPs can get reimbursement at a complete rate.  

However, in most cases, non-physician practitioners only get 85% of a healthcare provider’s scheduled rate. This happens when the services rendered are covered by Medicare.   

To acquire overall revenue, non-physician practitioners must utilize incident-to-billing accurately and efficiently. For that, they must know the important billing guidelines and understand how to incorporate them into the billing process.   

Important Aspects of Incident-to Billing   

Mastering medical billing is all about understanding the basics and putting them to use.   

Here are some vital aspects of incident-to-billing that NPPs must be familiar with, and they are:  

• As discussed above, a non-physician practitioner must render medical aid in the presence of a healthcare provider. This is because a healthcare provider must always be available to offer assistance when needed.   
• The initial visit of the patient must be with the healthcare provider, and the NPP can offer care during the follow-up visits. Even the plan of care must be guided by the healthcare provider.  
• Incident-to-billing is only considered when services are rendered in a non-intuitional setting such as a medical office or health clinic. It is not considered if the services are given at skilled nursing facilities or hospitals.   
• When NPPs offer their medical services, it must be in an outpatient setting where the patient can receive complete care.  
• The NPP offering care must be an employee within the same healthcare practice.  
• The NPP must be involved throughout the treatment plan and actively participate in providing care to patients.   
• Reimbursement rates under incident-to-billing are at 100% fee schedule rates. But if the NPP goes for direct billing, the rate is only 85%.  
• To ensure adequate revenue, there is a need for documentation according to incident-to-billing requirements.  
• Services to single-visit patients are not a part of incident-to billing. Only patients with a documented plan are subject to this type of billing.   

How to Know If You Are Eligible for Incident-to-Billing?  

Even though incident-to-billing is meant for non-practitioner physicians, healthcare providers can also get revenue under certain circumstances.   

‘Physician Assistants (PAs), Advanced Practice Registered Nurses (APRNs), Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), Certified Nurse Midwives (CNMs) and Certified Registered Nurse Anesthetists (CRNAs)’.  

These practitioners come under NPP, however, even if you are not one of them, you can still receive compensation under incident-to-billing. Let’s understand how.  

For Illustration  

Suppose a patient has to visit a medical facility for 6 months according to their treatment plan. Every time they show up for a regular checkup, they may not get an appointment with their initial healthcare provider. Whereas the patient is receiving care in continuation of the previous visit. This happens in situations where the patient has diabetes or any other medical ailment that requires regular screenings.   

Therefore, if a different healthcare provider offers care, they can receive revenue from incident to billing.   

There are certain conditions to this, but healthcare providers can claim full compensation for the rendered services.   

Here’s what you must ensure:  

• The patient must be receiving ongoing care based on a treatment plan.  
• The initial healthcare provider still acts as a supervisor and gives oversight even without being physically present.  
• Rendered services are just a follow-up procedure and a part of the treatment plan.   

Complex Guidelines Often Lead to Mistakes in Medical Billing!  

The multitude of rules makes incident-to-billing quite complex and leads to administrative errors. These complexities not only hamper the workflow but also restrict the growth of revenue cycle management.   

To reduce errors and prevent claim denials, NPPs need to seek help from where they can get the best assistance. Medical billing services successfully streamline the operational flow and help practitioners maximize their revenue.   

Attaining 100% reimbursement is not a challenge with professional medical billing services. If you specifically reside in Maryland, then there are various options for Medical Billing Services Maryland.   

However, choosing an expert in the field is necessary to ensure accuracy and efficiency at every medical billing step.   

Benefits of Partnering with a Medical Billing Company  

• Medical billing companies offer the proper skills and knowledge required to handle incident-to-billing.  
• They are well-versed in handling intricate coding requirements as they have a proper understanding of CPT, ICD-10 and HCPCS codes.  
• They ensure complete compliance with vital standards like HIPAA and other regulatory standards.  
• They solve the issue of denials with a proper denial management process and reduce revenue leakage.   
• Overall, they reduce the administrative burden and stress allowing practitioners to focus on offering quality care.  

Bottom Line   

Proper incident-to-billing is fundamental for non-physician practitioners to acquire desired revenue. The challenges create significant roadblocks and prevent practitioners from billing accuracy. However, medical billing services can solve all these issues and help practitioners achieve comprehensive revenue success.  

If you are searching for premium Medical Billing Services Maryland, then Eminence RCM is the right choice for you.   

Eminence RCM is a premium medical billing company offering top-notch incident-to-billing services to healthcare practices across the USA. Our proficient team of billers and coders minimize inaccuracies and enhance overall efficiency. We follow all regulatory standards, ensuring hassle-free medical billing and complete revenue. Our team successfully utilizes advanced technology to reduce manual mistakes and upgrade coding accuracy.    

Choose Eminence RCM and lead to a better incident-to billing!