The phrase “incident‐to” is used in two very different ways in the Social Security Act. For physicians and practitioners, "incident‐to billing" relates to physician coding and billing for subordinate staff services. For hospitals, “incident‐to services” describes the major benefit category for hospitals under the Medicare program. Hospitals are paid for “incident‐to services” provided by physicians. Confusion is created through the different ways in which "incident‐to" must be interpreted.

Proper compliance with all the rules and regulations that relate to both "incident‐to billing" and "incident‐to services" is a major challenge. In this workshop, we compare and contrast the two different interpretations, how to remain compliant in both cases, and the interplay between these two concepts. Special situations, for critical access hospitals and rural hospital clinics also will be included.

Objectives

• discuss the two different uses of the phrase, "incident-to" as provided in the Social Security Act

• discuss the incident-to billing for physicians

• explain physician supervision for both physicians and hospitals

• describe how incident-to is a compliance issue in multiple situations

• explain incident-to physician services in the provider-based clinic setting

• discuss how incident-to is involved in special situations, such as the three-day payment window, RHCs and telemedicine

Audience

All personnel involved with compliance, coding, billing and reimbursement; financial analysts; health information management personnel; financial personnel; patient financial services personnel; chargemaster coordinators; provider‐based clinic and/or clinical operations personnel; physicians and practitioners; and other interested personnel.