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Boost Your Clinic’s Efficiency with Incident-To Billing 

Unlocking the Potential of Incident-To Billing 

Imagine a healthcare system where clinics can see more patients, reduce waiting times, and boost their revenue without compromising on care quality. This is the promise of Incident-to billing, a Medicare-driven process that empowers Advanced Practice Providers (APPs) to work under the supervision of physicians more effectively. Since Medicare sets the gold standard for medical coding, other insurances follow its lead, making Incident-to billing a powerful, yet often underutilized, tool. By leveraging the established contracts of supervising physicians, APPs can streamline administrative tasks and help clinics run more smoothly. 

Navigating the Rules for Success 

To fully benefit from Incident-to billing, clinics must follow a specific set of guidelines. APPs are restricted to follow-up or continuing care for existing patients, meaning they cannot handle new patients or new medical issues. The supervising physician must be on-site when the APP is working, actively participating in the patient’s treatment plan, and must review and sign off on all charts prepared by the APP. Additionally, these services must take place in an office setting (Place of Service 11), and the APP must be credentialed by Medicare. Fortunately, credentialing can be backdated by 30 days, giving clinics a head start. It’s also crucial that the APP is a direct employee of the clinic. Importantly, healthcare facilities should educate themselves on government and Medicare reimbursement rules to navigate this process effectively. 

Reaping Financial and Operational Rewards 

The benefits of Incident-to billing extend beyond just administrative ease; they also have substantial financial implications. While APPs usually receive 85% reimbursement for their services under Medicare, billing through Incident-to allows them to use the supervising physician’s 100% reimbursement rate. This can significantly increase the clinic’s revenue. Moreover, since getting an APP credentialed and contracted with insurances can take up to 120 days, Incident-to billing provides a valuable interim solution, allowing clinics to see more patients sooner. This boost in patient volume not only enhances clinic efficiency but also improves access to care for patients, creating a win-win scenario for all involved. 

By understanding and implementing Incident-to billing, healthcare facilities can optimize their operations, better serve their patients, and ensure financial stability. Therefore, the healthcare facilities’ educating their patients and their Advanced Practitioners on the Medicare and government reimbursement rules is the key to unlocking these benefits. 

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