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Course

Incident-To Services

Instructor

Faye Grile, CCS-P, CDIP, CPC, COC, CPCO, CPMA, CEMC

Description

In this course, you will gain a comprehensive understanding of the intricacies surrounding services provided incident to a physician's care by non-physician providers (NPPs). Delve into the definitions, CMS criteria, and coverage guidelines for these services, while exploring the essential concept of 'immediately available' supervision. Learn to navigate various place of service settings and exceptions, such as shared visits, all while considering the organizational impact and implications of incident-to billing.

Included Lessons:

  • What Are Incident-To Services
  • Definitions
  • CMS Criteria For Incident-to Services
  • Place Of Service Settings For Incident-To
  • Shared Visit-Incident-To Exception
  • Coverage
  • Organizational Impact
CEUs available for the following credentials:

AAPC

COC, CPC, CPC-P, CANPC, CASCC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMA, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC

AHIMA

CCA, CCS, CCS-P, RHIT, RHIA, CDIP, CHDA, CHPS

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Key Takeaways

  • Understanding of Incident-To Services: Gain a comprehensive understanding of what incident-to services entail, including the concept that these services are provided by non-physician providers under the supervision of a physician.
  • CMS Criteria Mastery: Master the CMS criteria governing incident-to services, such as the requirement for the physician's active involvement, billing procedures, and the necessity for services to be an integral part of the patient's treatment course.
  • Place of Service Knowledge: Familiarize yourself with different place of service settings for incident-to services, including those where incident-to services can and cannot be performed, and the significance of physician presence in certain settings.
  • Shared Visit Expertise: Learn about shared visits and the exceptions that apply in the context of incident-to billing, including when an E/M service can be billed under the physician's UPIN/PIN.
  • Coverage Guidelines: Understand the coverage guidelines for clinical personnel providing services incident to a physician or NPP, including the types of services that can be billed and the specific coding requirements.
  • Organizational Impact Considerations: Explore the organizational impact of incident-to billing, with a focus on how these rules apply to Medicare and the potential for incident-to billing with other insurance carriers. Understand the importance of reviewing payer contracts and state guidelines for compliance.
  • Documentation Proficiency: Develop skills in documenting incident-to services, with a particular emphasis on distinguishing between new and established patient problems to determine when incident-to guidelines are applicable.
  • Compliance and Billing Efficiency: Learn how to code and bill for incident-to services accurately, ensuring compliance with Medicare regulations and optimizing reimbursement for healthcare organizations.

Benefits of Taking this Course

  • Master Incident-To Definitions
  • Enhanced Coding Skills
  • Understand Incident-To Services
  • Navigate Coverage Guidelines
  • CMS Criteria Mastery

FAQs

What exactly are incident-to services?
Incident-to services refer to healthcare services provided by non-physician providers (NPPs) under the supervision of a physician. These services can be billed under the physician's NPI.
Which place of service settings allow for incident-to services?

Incident-to services can typically be performed in non-hospital-based clinics (POS 11), but they cannot be provided in the emergency room (POS 23) or in inpatient hospital settings (POS 21) or hospital outpatient departments (POS 22) without the physician's physical presence.

Are there variations in incident-to rules for different insurance carriers?
While incident-to rules primarily apply to Medicare, other insurance carriers may have their own guidelines. It's important to review payor contracts to understand how incident-to services are reimbursed by different carriers.

About our Medical Coding Courses

HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for more than three decades—offers a comprehensive online education platform for medical coders. With a catalog of over 200 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection approved by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPT, E/M, ICD-10-CM, ICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatient, outpatient, profee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CM, ICD-10-PCS, CPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams.
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Overview
Price
Price : $35.99
Courses
Courses : 1
CEUs
AHIMA CEUs : 1
CEUs
AAPC CEUs : 1
Code Type
ICD-10-CME&M