• Swathi Lakshmi

Changes to Incident-To Billing Guidelines from CMS

Medical providers have had to make some rapid adjustments due to the COVID19 outbreak of 2020, which has led to some confusion and frustration when it comes to billing. The Department of Health and Human Services (DHHS) has made some significant changes to accommodate this new landscape, and many providers are now trying to figure out how to deal with billing issues while also maintaining the front lines against the pandemic. The Centers for Medicare and Medicaid Services (CMS) published an Interim Final Rule in March 2020 which has some telemedicine changes providers should know about. Here's a hidden gem within the rule changes that impacts "Incident-to" billing.

The Original "Incident-To" Rule

During normal times, a physician is required to supervise when a nurse practitioner or physicians assistant performs an "incident-to" procedure. If that condition is not met, the procedure cannot be billed as an "incident-to" under Medicare rules. Here's how the original rule defined "direct supervision" under §410.32(b)(3)(ii):

"The physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed."

The Temporary "Incident-To" Rule Change

With the Interim Final Rule from CMS, that direct supervision can now be provided via telemedicine technology. Here's what the rule change says:

"For the duration of the PHE (Public Health Emergency) for the COVID19 pandemic, direct supervision can be provided using real-time interactive audio and video technology."

This means that the physician can supervise from a remote location, and so long as audio and video technology are used, these incidental procedures can be billed as an "Incident-To" to Medicare.

Note that it must be interactive audio and video under the rule change. This means the physician can't be monitoring the procedure via telephone only, or a video feed only. It's also important to note that this is a temporary rule change that will sunset once we put this public health emergency behind us.

Why This Change Is Important

Hospitals, clinics and other care facilities are taking extraordinary measures to slow the spread of COVID19 and "flatten the curve." In some cases, facilities are treating COVID19 patients in one location, while isolating all other patients in another facility. This rule change can help physicians reduce the amount of face-to-face appointments with non-COVID19 Medicare patients, who may be at increased risk of contracting the virus.

If they can reduce the number of people that have to be in an exam room for "Incident-To" procedures, that's a win-win for doctors, nurse practitioners, physicians assistants and patients. The rule change also allows Medicare to continue to cover "Incident-To" procedures. And who knows? If telemedicine use proves effective in reducing the spread of COVID19, influenza and other illnesses, perhaps CMS will make the rule change permanent when this emergency is over.

That's just one rule interim change that has gone into effect on very short notice as a result of COVID19. We'll keep you up to date if we find any other significant billing changes that providers need to know about.

For any queries, please write to contact@empclaims.com


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