There are many ways in which mid-level provider visits can violate the incident-to rules. Without an audit, your Medicare carrier won’t know that the rules have been violated since a claim for an incident-to service looks exactly like a claim from the supervising provider. However, audits are triggered when CMS sees a significant number of services for a single physician because both the provider and the APP are billing under the physician’s National Provider Identifier (NPI).

CMS is frustrated with the continued non-compliance in this area. Listen in this week, as Terry clarifies the rules, regulations, and how to be audit-proof when reporting Advanced Practice Providers services under the incident to billing rule.

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