incident to billing

Hi,
I saw on the MGMA listserv this morning that incident to billing is by state. In other words some states allow incident to billing and some don't. Can anyone confirm this and provide a resource showing which states do not allow it?
Thanks for any info.

incident to billing

Incident to billing is a Medicare rule, and as such, is national. Search for an article about it on Codapedia by putting the key words incident to into the search box. It specifically allows for a physician group to bill for services provided by someone other than the physician under the physician's NPI. Medicare has detailed and specific rules for it. It is a compliance issue.

Most state Medicaid programs follow incident to rules: check those state by state, because I hear about twists all the time: for OB, the resident can do the visits without the MD in some states, physician on site variation, etc.

Private payers decide for themselves whether to enroll and credential NPPs (and thus, pay for them under their own provider numbers, usually at a lesser rate) or whether they want to have you bill for the NPPs under the MD's provider number.

Supervision/collaboration is entirely different, and varies by state. PA's typically need a supervising MD, usually that MD doesn't have to be on site, and this has nothing to do with how it is billed to the payers. Some payers require a collaboration agreement for NPPs. NPs are allowed to work independently for Medicare. Again, that is different from reimbursement.

Clear as mud?

incident to billing

Thanks so much for the help. I figured this issue was payor driven and not state.
I appreciate it.