Medicare will pay the higher physician rate for services rendered by non-physician providers (NPP) if the services are “incident to” the services of a physician. Services must be provided under the direct supervision of a physician.
However, for years now, I have cautioned providers about billing “Incident-To” given the level of complexity. In 2017, I assisted OIG with a study tied to Incident-To Services. As I participated in discussions with auditors, investigators, and special counsel, it was clear that NPPs needed to be credentialed and bill under their own number. The minimal financial difference is not worth the risk as detailed in a settlement just released Friday, October 30,2020 by the DoJ (Memphis Physicians Agree to Pay More than $340,000 for Alleged Overbillling). This settlement was the result of a qui tam that alleged the physicians violated the False Claims Act.
By Sean M. Weiss, Partner, Vice President, and Chief Compliance Officer
Sean M. Weiss is a Partner and Chief Compliance Officer for DoctorsManagement, LLC. Sean provides strategic litigation defense services and a host of regulatory compliance services for clients nationally.
Learn more about Sean’s expertise at www.thecomplianceguy.com.
What to do next…
- If you need help with an audit appeal or regulatory compliance concern, contact us at (800) 635-4040 or via email at [email protected].
- Read more about our: Total Compliance Solution
Why do thousands of providers trust DoctorsManagement to help improve their compliance programs and the health of their business?
Experienced compliance professionals. Our compliance services are structured by a chief compliance officer and supported by a team that includes physicians, attorneys and a team of experienced auditors. The team has many decades of combined experience helping protect the interests of physicians and the organizations they serve.
Quality of coders and auditors. Our US-based auditors receive ongoing training and support from our education division, NAMAS (National Alliance of Medical Auditing Specialists). All team members possess over 15 years of experience and hold both the Certified Professional Coder (CPC®) as well as the Certified Professional Medical Auditor (CPMA®) credentials.
Proprietary risk-assessment technology – our auditing team uses ComplianceRiskAnalyzer(CRA)®, a sophisticated analytics solution that assesses critical risk areas. It enables our auditors to precisely select encounters that pose the greatest risk of triggering an audit so that they can be reviewed and the risk can be mitigated.
Synergy – DoctorsManagement is a full-service healthcare consultancy firm. The many departments within our firm work together to help clients rise above the complexities faced by today’s healthcare professionals. As a result, you receive quality solutions from a team of individuals who are current on every aspect of the business of medicine.
