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Non-Physician Provider Billing:
Incident-to OR Direct Billing

Non-Physician Provider Billing: Incident-to OR Direct Billing


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Speaker: Mary LeGrand


" "Incident to" " and " "Direct Billing" " are Medicare concepts for non-physician provider billing. These two billing methods have very different requirements and Medicare reimbursement varies based on the two billing methods. Understanding the differences is critical for the medical practice -- to ensure accurate reporting of services to Medicare and to ensure that the practice receives the reimbursement that the practice deserves.

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Now is the time to review the practice management business operations and to confirm that the requirements are in place to appropriately report services for Non-Physician Providers (NPP)? If you have Non-Physician Providers in your practice, this is the audio conference for you.

These providers may include Physician Assistants (PA), Nurse Practitioners (NP), Clinical Nurse Specialists (CNS), Physical Therapists (PT), Occupational Therapist (OT), Speech Therapists (ST), or Nurse Midwives.

Listen and learn:

  • Precise definitions of " "Incident to" " and " "Direct Billing" "
  • Physician supervision requirements for each billing method
  • Rules on reporting New Patients, Consultations and Established
  • Patients under the " "Incident to" " and " "Direct Billing" " methods
  • Definition of shared visits versus split billing
  • The difference between " "Diagnostic Supervision" " Rules and " "Incident to" " Rules
  • Hear the review if OIG focus on Incident to services
  • Problem areas.for reporting services for Non-Physician Providers
  • Meet Our Expert Speaker:

    Mary LeGrand works with physician practices in solo, group, multi-specialty and academic settings to provide education to physicians and staff on coding and reimbursement system issues, to evaluate reimbursement processes in the practice, and to improve clinical and financial operations. Ms. LeGrand uses her nursing and administrative clinical skills to give strength to coding and reimbursement issues -- expertise not typically found in the coding arena.

    With over 30 years of professional nursing, administrative and consulting experience, Ms. LeGrand brings the necessary skills and savvy needed in change management projects. She also develops and presents customized coding and documentation workshops tailored to practices' specific needs. Her reviews of E&M services and surgical services ensure that physician documentation supports the services reported and identifies opportunities where revenue leaks may exist.

    Ms. LeGrand is a Consultant and Speaker with Karen Zupko & Associates.