Psychiatric-Mental Health Nurse Practitioner Exam

What does 'incident to' refer to in a billing context?

1. A billing rate of 100% if the physician is available

2. A billing rate of 80% regardless of supervision

3. A separate billing entity

4. A special patient status

The correct answer is: A billing rate of 100% if the physician is available

The term 'incident to' in a billing context refers to services provided by non-physician practitioners that are billed under the physician’s National Provider Identifier (NPI) when the physician is present in the office and available to provide direct supervision. When services are billed 'incident to', they are reimbursed at the same rate as those services rendered directly by the physician, which is typically at 100% of the allowable amount. This arrangement provides a way for practices to utilize non-physician staff, such as nurse practitioners or physician assistants, while allowing the practice to bill for their services at the higher physician rate, thus maximizing reimbursement. To qualify for 'incident to' billing, certain criteria must be met, including that the services performed are integral to the physician's service. The other options do not accurately represent the meaning of 'incident to' in the billing context. Thus, the focus on the billing rate of 100% when the physician provides supervision makes the understanding of 'incident to' crucial for accurate billing practices.