APMA News - May 2011 - (Page 56)

Reimbursement By Jon R. Goldsmith, DPM Incident to Services Your practice may engage in performing “incident to services.” You may have heard the term, but do you know what it means to provide incident to services or how they affect your practice? First, the good news. Incident to services enable the doctor to delegate services, allowing ancillary staff to assist in minor care, adding revenue to the bottom line and improving care and productivity. But there’s a catch: incident to services are typically regulated under Medicare (the government and other payers allow incident to services to be performed within doctors’ offices), meaning there are specific “do’s and don’ts” regarding proper performance and billing. Incident to provisions allow services to be provided by non-physician staff in an office setting. Incident to services are reimbursed at 100 percent by billing those services under the physician’s national provider identifier (NPI). Medicare criteria for meeting incident to services are: 1. The service must be typically performed in a physician’s office setting; 2. The incident to service performed must be allowed under the scope of practice, license, certification, or state rules and regulation of the non-physician practitioner (NPP) or staff performing it (the incident to services provided by the NPP or staff must be a service within the billing doctor’s scope of practice); 3. Prior to incident to services being rendered, the doctor must personally treat the patient either on his or her first visit or, in the case of an established patient, on the initial visit where there is a new complaint/new medical condition; and 4. The doctor must be in the office (on site) when the NPP or staff renders incident to services. Even though the patient receives incident to services, the doctor must continue to see the patient for overall management. An example of an incident to service would be a patient who returns for follow-up for an ankle fusion and requires a cast application. If a nurse applies the patient’s fiberglass cast (if allowed by state rules) after the podiatrist has seen the patient and approved cast application and while the podiatrist is in another room with a patient, the NPP’s cast application would qualify as an incident to service. The work performed and materials used by the assistant are billed under the doctor’s name and NPI. 56 APMA News May 2011 The key is to remember that “incident to” is defined, in part, as “services furnished as an integral although incidental part of a physician’s personal professional service” (Medicare Benefit Policy Manual). Two important adjectives here are “integral” and “incidental.” CMS defines “integral” services as “services as related to an initial covered service and … both essential and connected to the physician’s delivery of care related to an initial service.” CMS notes that “incidental” services have three main criteria: 1. The service has an important role in the initial service; 2. The service is supplemental and not a significant service of its own; and 3. The service is not addressing a new diagnosis. The cast application example is part of typical follow-up to surgery (ankle fusion), which itself resulted from a workup and conservative treatment (limited or extensive) for a complaint of activity-limiting ankle pain. Casting is essential for immobilization and relates directly to the diagnosis of ankle arthritis, which was treated by the initial service and subsequent surgery. Another example: a medical assistant applies an impression cast for custom-made foot orthoses in a patient diagnosed by the podiatrist with an unstable, flexible pes planovalgus deformity that failed conservative care and could not be controlled with prefabricated foot orthoses. Podiatrists use medical assistants to provide certain incident to services. CMS identifies nurse practitioners, clinical nurse specialists, physician assistants, and nurse midwives as potential, but not exclusive, NPPs. Depending on state regulations, not all of these NPPs are permitted to be supervised by a podiatrist. If state law or rule permits medical assistants to perform certain services, your responsibility as a podiatrist is to know what the scope of practice or care rule is for medical assistants under your supervision. It is your responsibility to ensure they are trained (and take relevant continuing education courses) and experienced in performing the specified incident to services. n Contact Dr. Goldsmith at coding.hpp@apma.org.

Table of Contents for the Digital Edition of APMA News - May 2011

APMA News - May 2011
President’s Message
Contents
APMA Educational Foundation Annual Giving Campaign
91st House of Delegates: Focused on the Future
Roth: To Convert or Not to Convert?
Surgical Workshops at The National Offer Hands-on Instruction
Annual Scientific Meeting Preliminary Program
Annual Scientific Meeting Registration Form
Annual Scientific Meeting Sponsors
PICA and Podiatric Medicine: Family Ties Run Deep
Attaining Parity in California
Affordable Care Act, One Year Later: Part One
Reimbursement
Members Who Know Media
Technofile
Young Voices
Small Business 101
In Short
APMA Out and About
Worthy of Note
APMAPAC Update
Affiliates Corner
Insurance Advisor
Development Update
New and Deceased Members
2011 Call for Awards Nominations
Classified Advertising
Dates to Remember
Advertising Index

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