The phrase Incident-to is used in two very different ways in the Social Security Act (SSA). For physicians and practitioners, this phase is used for incident-to billing that relates to physician coding and billing for subordinate staff services. For hospitals, the phase is incident-to services that describe the major benefit category for hospitals under the Medicare program. Hospitals are paid for services that are incident-to services provided by physicians. Confusion is created through the very different ways in which incident-to must be interpreted.

Proper compliance with all the rules/regulations that relate to both incident-to billing and incident-to services is a major challenge. In this workshop, we compare and contrast the two different interpretations, how to remain compliant in both cases, and the interplay between these two concepts. Special situations such as for CAHs and RHCs will also be included.

Session Objectives:-

• To review and discuss the two different uses of the phrase, incident-to, as provided in the Social Security Act (SSA).
• To discuss the incident-to billing for physicians.
• To appreciate hospital payment relative to incident-to physician services.
• To understand physician supervision for both physicians and hospitals.
• To discuss hospital benefit categories under the SSA.
• To understand how incident-to is a compliance issue in multiple situations.
• To show how the incident-to concept applies to recently changed physician supervision requirements.
• To discuss incident-to physician services in the provider-based clinic setting.
• To review how incident-to is involved in special situations such as the 3-Day Payment Window, RHCs, and telemedicine.
• To appreciate how the rules for supervision have morphed over time.
• To understand the nonenforcement of the supervision rule for CAHs and small rural hospitals.
• To work through several case studies to illustrate the intricacies surrounding the incident-to concept.

Session Agenda:-

• Introduction
  • Overview of the Incident-To Concept
  • Areas of Applicability of Incident-To Services
  • Compliance Concerns Surrounding the Incident-To Concept
  • Physician Supervision Requirements
• Incident-To and The Social Security Act
  • Physician Payment Through Incident-To Services
  • Hospital Payment Through Incident-To Services
  • Self-Administrable Drugs
  • Understanding the Two Different Uses of the Phrase Incident-To
  • Hospital Services Benefit Categories
• Incident-To Billing for Physicians
  • Physician Billing For Subordinate Staff Services
  • Presumptive Freestanding Clinic
  • Specific Requirements for Physicians
  • Physician Supervision Requirements
  • Special Concerns for Non-Physician Practitioners
• Incident-To Services for Hospitals
  • Hospital Payment For All Services Incident-To Physicians
  • Presumptive Provider-Based Setting
  • Physician Supervision Rules
  • Specific Impacts of Hospitals
• Physician Supervision
  • Special Requirements for Freestanding Clinics
  • Special Requirements for Hospitals
  • Documenting Physician Supervision
• Associated Impacts of the Incident-To Concept
  • Provider-Based Rule
  • 3-Day Payment Window
  • RHCs
  • CAHs and Small Rural Hospitals
  • Telemedicine
• Case Studies

Who Will Benefit:-

• Healthcare Executives
• Financial Analysts
• Coding and Billing Personnel
• Compliance Personnel
• Financial Personnel
• Patient Financial Services Personnel
• Chargemaster Coordinator
• Provider-Based Clinics
• Clinical Operation Personnel
• Physicians
• Non-Physician Practitioners