Doctors who employ nurse practitioners (NPs) and physician assistants (PAs) may soon become the focus of increased scrutiny, as the U.S. Department of Health and Human Services (HHS) has announced plans to monitor Medicare covered services performed by non-physician employees more closely.
This additional focus comes on the heels of the agency’s announcement that “incident-to” services are vulnerable to overutilization and expose patients to subpar care.
Medicare Part B currently allows for “incident-to” services performed by professional physician assistants and nurse practitioners. But HHS plans to review these claims to determine whether other types of employees at a medical practice performed such services.
The reason for the increased attention is a spike in the billing for “incident-to” services that’s occurred in recent years.
Of course, proper “incident-to” services should pass scrutiny. For example, a patient seeing an NP for counseling after previously obtaining a diagnosis from a physician qualifies for 100% of the Medicare fee schedule since it was “incident-to” the original visit.
Yet, a 2009 review found that 21% of “incident-to” services were actually performed by unqualified non-physicians or didn’t fall under the guidelines outlined by OIG, which explains the concerns about patients being exposed to shoddy care.
So what can a private practice do to avoid falling under the watchful eye of HHS’ investigatory agency? Just keep in mind the “incident-to” criteria, when having non-physicians see patients:
– Services must be provided in a physician’s office or clinic.
– A physician must see all new Medicare patients before a non-physician does. During the initial visit, a diagnosis and treatment plan should be established. After that, it’s acceptable for a PA to see the patient for follow-ups.
– The above applies for existing Medicare patients with new conditions.
– The physician must be somewhere on-site during a PA or NP patient encounter.
– The PA or NP must be certified to perform the services provided.
– The services of non-physicians must be identified on the physician’s bills.
If you adhere to these simple benchmarks, there should be no reason for Medicare to reject any of your non-physician services. However, if not, you may fall into hot water with HHS and Medicare.
