The Medicare Payment Advisory Commission’s unanimous recommendation that Congress do away with “incident-to” billing could have a strong effect on physician assistants and nurse practitioners—and therefore, considering the growing role PAs and NPs play in this setting, on urgent care overall. If incident-to billing is eliminated, PAs and NPs will have to bill independently and at a lower reimbursement rate than they do now. Currently, the services of PAs and NPs who are truly assisting the physician can be billed at 100% under the physician’s license. Those same services are reduced by 15% by some payers if those clinicians are working more independently. Elimination of incident-to billing would mean PAs and NPs would have to bill independently, on their own license, exclusively going forward. Dr. David Stern addressed aspects of this issue in a Revenue Cycle Management Q & A column. You can read The Incidentals of ‘Incident-to’ Billing in the JUCM archive.
What Would Doing Away with ‘Incident-to’ Billing Mean for NPs and PAs—and Urgent Care?