What You Should Know About Incident-to Billing Compliance

In February of 2020, a family physician in Knoxville, Tennessee paid $285,000 to settle allegations that he failed to properly supervise nurse practitioner services billed at the higher physician rate.

In January, 2018, a healthcare system in San Diego, California paid $1.5 million to settle allegations that physical therapy services were inappropriately billed in physicians’ names, when they did not provide the appropriate supervision required under the circumstances.

What do these two, and countless other, settlements have in common? The underlying legal issue of these settlements was their failure to follow “incident-to” billing regulations.

““Incident to” services are defined as those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office suite or within an institution) or in a patient’s home. These services are billed as Part B services to your carrier as if you personally provided them, and are paid under the physician fee schedule.”

Because fraudulent, abusive and wasteful billing practices contribute so significantly to the rising cost of healthcare in the United States, The DOJ and OIG spend a great deal of their time and resources investigating false claims accusations, whether because of whistleblower complaints or their own audits.

But how do you know if your billing department is compliant with the Incident-to billing? Join our upcoming webinar, “What Compliance Officers Should Know About Incident-to Billing,” to see the potential risks facing your compliance program, and how you can:

• Leverage Enforcement Cases Where “Incident-to” Billing Was Done Inappropriately
• Understand the “Incident-to” Compliance Rules, Regulations, and Risks
• Take Steps to Avoid Issues of Non-compliance

For those of you in attendance, you’ll also be eligible to receive 1.2 HCCA CCB credits. I hope to see you there!