What is the classification of incident-to services when performed in a facility setting?

What is the classification of incident-to services when performed in a facility setting?

• A. They can be coded and billed
• B. They cannot be billed
• C. They are covered at 90%
• D. They require the physician's direct involvement

Answer: (B)

Incident-to services refer to services that are provided by a non-physician practitioner or provider under the direction and supervision of a physician. In a facility setting, such as hospitals or nursing homes, the classification of these services changes significantly. In this context, incident-to services cannot be billed separately. Instead, they are bundled into the facility's overall service reimbursement. This is because facility settings have different regulations and reimbursement structures compared to outpatient settings, where incident-to billing is more common and can be done under specific conditions. For example, in an outpatient office, incident-to services can be billed under the physician's NPI if certain criteria are met, including the requirement for the physician to be present in the office when services are rendered. However, in a facility, these stipulations are not applicable, leading to the conclusion that incident-to services cannot be billed. Therefore, the classification that incident-to services cannot be billed in a facility setting aligns with CMS guidelines regarding facility services. Understanding this distinction is crucial for accurate coding, billing, and compliance with healthcare regulations.

Incident-to services refer to services that are provided by a non-physician practitioner or provider under the direction and supervision of a physician. In a facility setting, such as hospitals or nursing homes, the classification of these services changes significantly.

In this context, incident-to services cannot be billed separately. Instead, they are bundled into the facility's overall service reimbursement. This is because facility settings have different regulations and reimbursement structures compared to outpatient settings, where incident-to billing is more common and can be done under specific conditions. For example, in an outpatient office, incident-to services can be billed under the physician's NPI if certain criteria are met, including the requirement for the physician to be present in the office when services are rendered. However, in a facility, these stipulations are not applicable, leading to the conclusion that incident-to services cannot be billed.

Therefore, the classification that incident-to services cannot be billed in a facility setting aligns with CMS guidelines regarding facility services. Understanding this distinction is crucial for accurate coding, billing, and compliance with healthcare regulations.