Wiki INCIDENT TO PROVIDER

Hello, Medicare in the final rule had mentioned that LMFT,MHC would not require incident to provider. However there are many carriers that are denying such implementation, or like Tricare that said that they have yet to update on their end. I was wondering if there's a website or place were I can be directed to, to get further insight in regards to incident to or perhaps a training of some sort. This way I am able to provide correct information on to who needs incident to and not.
I greatly appreciate any feedback.
TIA.

Have you checked the Medicare benefit policy manual? https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c15.pdf

Would the "incident to" apply if an APRN is performing medical services on the supervising physician when the supervising physician is also the patient?

lvoight@humana.com said:

Would the "incident to" apply if an APRN is performing medical services on the supervising physician when the supervising physician is also the patient?

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While I've never seen this specified, if you think out the logic, I don't see how incident-to could apply. The patient couldn't be the onsite, immediately available physician. A physician cannot bill for treating themselves. This service would be billed under the servicing provider.

csperoni said:

While I've never seen this specified, if you think out the logic, I don't see how incident-to could apply. The patient couldn't be the onsite, immediately available physician. A physician cannot bill for treating themselves. This service would be billed under the servicing provider.

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Thank you for your help! I have been looking for resources that also specifically state that a provider cannot bill for treating themselves but have yet to find that. All I've found is that it is ethically frowned upon. If you have a resource, would you mind sharing? I appreciate any help!

I am no compliance expert, but I believe this likely falls under Stark regulations. For non government plans, it is most likely in your payor contract.
In general, a physician is not prohibited from treating themselves and/or immediate family. It is generally not a good idea to do so for several reasons (why it's ethically frowned upon), therefore not often done. Billing for that service is a different matter, and falls under the payor's policies. I have never seen a contract that permitted it.
Let's take your example. There's a 15% allowable difference to bill under the ACP vs MD. Let's say there were $300 worth of services, so $45. Are you really going to spend hours becoming an expert in insurance regulations? Pay a healthcare attorney to ensure it is allowed? Have to deal with insurance queries and/or investigations? Potentially cause legal issues for $45? I've never worked for a practice that didn't take the common sense (safe) route.