Which group of professionals should be part of the same billing entity for incident-to services?

The collaboration between physicians and non-physician practitioners (NPPs) is essential for delivering comprehensive patient care, particularly when it comes to incident-to services. When these services are billed, they must originate from a physician's service to bill at the physician's higher reimbursement level. For this to be permitted, both the physician and the NPP must be part of the same billing entity.

Incident-to services are typically those that are performed by NPPs, such as nurse practitioners or physician assistants, but they must be carried out under the supervision of a physician. To qualify for billing as incident-to, the physician must have established a plan of care, and the services need to be an integral part of that established plan.

By having NPPs and physicians in the same billing entity, practices can ensure compliance with Medicare regulations, maximize revenue, and enhance the efficiency of care delivery. The close working relationship promotes seamless integration, which is necessary for incident-to billing to be successful and legitimate in the eyes of payers.