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The question keeps coming up as to whether my nurse practitioner can bill incident-to while counseling patients and bill based on time spent counseling. I get mixed reports on this. What is the answer? Can they bill by time?
Q: The question keeps coming up as to whether my nurse practitioner can bill incident-to while counseling patients and bill based on time spent counseling. I get mixed reports on this. What is the answer? Can they bill by time?
A: According to Medicare, the nurse practitioner cannot bill based on time when performing services “incident-to.” It may not make much sense, given that they can perform the same services as physicians relative to history, exam and decision-making, while practicing in the room next to you, independent save for the overall constraints of incident-to. But that is where Medicare has come down on this question.
In the March 2016 update to the Medicare Claims Processing Manual Chapter 12 you will find the following guidance):
The general trend is towards more of this kind of thing rather than less. But remember that this is Medicare (and likely all governmental programs.) It is unusual for commercial payers to say much at all about incident-to, much less at this level.
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