When all Medicare incident-to requirements are met for an APP office service, how does billing under the physician typically compare with billing under the APP?
Select an answer to reveal the explanation.
Short Explanation
Hit every incident-to checkbox and you can often bill under the physician at the full physician rate. Miss the checklist and you’re usually in APP direct-billing land at the reduced percentage. Eligibility decides which wallet you open.
Full Explanation
Medicare’s financial distinction is central to incident-to decisions: qualifying incident-to services are billed under the supervising physician and paid at the full physician fee schedule rate, while services billed under an APP NPI are generally paid at a reduced percentage. Incorrectly billing incident-to when requirements are unmet can constitute an overpayment. Coders should confirm eligibility before choosing the rendering/billing construct.