When can incident to billing no longer be used?

Incident to billing is a reimbursement mechanism that allows non-physician practitioners, such as nurse practitioners, to bill for services rendered under the supervision of a physician. This billing approach is typically applicable when the patient has an established relationship and it is related to ongoing care.

When the nurse practitioner treats a patient for a new issue, the incident to billing can no longer be applied because this scenario signifies that the patient does not have an ongoing relationship with the physician regarding that new condition. For incident to billing to be applicable, the services must be a continuation of a plan already established by a physician, usually for issues that the physician has previously addressed. Therefore, treating a new issue requires the nurse practitioner to establish a new patient relationship and billing must occur under their own practitioner identification, not under incident to.

In contrast, other situations like patient discharge, not being seen for over a year, or if the physician has retired do not directly interrupt the nature of incident to billing as much as the introduction of a new issue does. Thus, recognizing when a new issue arises is crucial in determining the proper billing method for healthcare services.