SECURITY HBMA nPP can bill incident-to services under the physician’s medicare provider number, which will result in 100% reimbursement under the medicare Physician fee schedule for services performed. therefore, the health care provider who employs nPPs must fully review state laws in order to ensure that proper billing is submitted to medicare for reimbursement. the most important state law regulation to consider when billing incident-to services is the level of supervision required by a physician when an nPP treats a patient. some state laws allow nPPs to bill under the physician’s medicare provider number when conducting incident-to services that relate to the physician’s course of treatment without requiring the physician to be physically present during the meeting. the incident-to services must be part of the physician’s course of diagnosis or treatment of an injury or illness, and the physician must supervise the services provided to the patient by the nPP. state law will define “supervision” as it is to be applied to medicare billing. for instance, some states do not require the supervisory physician to be present in the room, nor does the physician have to provide any care during a patient visit. however, a physician in a supervisory role must still be “present on the premises” and immediately available to assist the nPP in providing services if necessary. state law can also define the specific meaning of “present on the FEATURE story premises.” similarly, the location where the services are provided will affect the way in which billing is submitted to medicare, because incident-to services performed by an nPP in a hospital are directly paid to the hospital, and hospitals are reimbursed differently under medicare. With these factors in mind, it is imperative for the health care providers who employ nPPs to verify state law for regulations regarding the location, scope of practice, and level of supervision required for an nPP when billing medicare – especially since these laws are constantly changing. Preparing your clients practices’ for the government’s increased scrutiny of fraudulent billing and overpayments are crucial. therefore, it is important to meet with your legal counsel to identify risks and discuss preventive measures to ensure your doctors are in compliance with state and federal laws and regulations. Richard R. Wier, Jr. is a former Delaware Attorney General. Mr. Wier brings to his clients over 35 years of counseling and litigation experience in the areas of labor and employment and health law in Delaware, Pennsylvania, and nationwide. He is admitted to practice before the United States Supreme Court and the supreme courts of Delaware and Pennsylvania. Members Only take advantage of all your membership advantages in hbma. log on to www.hbma.org and click on Members Only to access tools, discussion boards, announcements, reports, and much more. membership has its benefits. find out today! the journal of the healthcare billing and management association 25
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