Published June 11, 2019

Medicare reimbursement for nonphysician (“NPP”) and ancillary services may be captured at different percentages of the physician fee schedule (“PFS”) rate. When billing NPP’s services, Medicare’s “Incident To” and “Split/Shared” service provisions, depending on the setting, are also options to consider. These practices can result in rates that are equal to the reimbursement received as if the physician were rendering the services personally. While reimbursement might be more attractive for this practice, there are strict requirements that must be met to justify the additional payment amounts. For those considering ‘Incident To’ and ‘split/Shared’ billing practices, this presentation will provide the history of such concepts and how a hospital or physician office can structure the patient care workflow process to remain compliant with all Medicare requirements. The presentation will also address all too common weaknesses or misses in the industry that have been the focus of government investigations into non-compliant practices.

Speaker: Jodi Nayoski, CPC, CCS-P, CHC, CDIP