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Format: On-Demand Webinar
Presenter: Amanda L. Waesch, ESQ.
Time: You can access the webinar anytime
Duration: 60 minutes
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Medicare physician supervision rules and requirements are complex and confusing. You must master Medicare’s complex Incident-To supervision and billing rules to maximize your Physicians, NPPs & Mid-level provider’s reimbursement. This webinar will explore the fundamental elements of billing for services “Incident-To” a physician, Non-Physician Practitioners and Mid-Level Providers. The presentation will walk through the Medicare requirements for “Incident-To” billing. This webinar will also explore common examples to understand the intersection of “Incident-To” billing with state supervision requirements. Lastly, we will discuss recent enforcement actions to failing to compliantly bill services under the Medicare “Incident-To” rules.

Learning Objectives

  • Understand the Medicare incident-to billing rules for Physicians, NPPs and Mid-level Providers
  • How state law may differ from Medicare and Commercial Payor requirements and how to balance it all
  • How do the different types of supervision impact services like Incident-to and Split/Shared Services
  • Review which services can be billed incident to a physician.
  • Understand whose services can be billed incident to a physician.
  • Understand proper documentation requirements
  • Review the requisite supervision necessary for incident to billing
  • Explore common examples faced in by providers
  • Review recent enforcement actions
  • Identify common best practices

Areas Covered in the Session

  • What is “Incident-To” Billing?
    • Applies Only to Medicare
    • Allows “physicians” to bill outpatient services provided by non-physician practitioners (“NPPs”)
  • Physicians
  • Non-Physician Practitioners (“NPPs”)
  • Reimbursement for “Incident-To” Services
  • Reimbursement Without “Incident-To” Billing
  • All providers must be licensed and providing services within their scope of practice
  • “Incident-To” Billing: The Law
  • 42 C.F.R. § 410.26: Conditions for “Incident-To” Billing
  • Non-Institutional Settings
  • Common Issues
  • Designated care management services under general supervision of the physician
    • G0502, G0503, G0504, G0507, CPT code 99487 and CPT code 99489
    • G0500: Behavioral Health Management services
    • CPT codes are for Complex Care Management
  • Example: Ohio Supervision Requirements
  • Example: Florida Supervision Requirements
  • Supervision Example
  • “Incident-To” Billing: Examples
  • Physician Fee Schedule 2024 Updates – “Incident-To”
  • Medicaid and “Incident-To”
  • State Specific Laws
  • More State Law Examples
  • Benefits & Noncompliance
  • Pros & Cons
  • Noncompliance: OIG Concerns
  • Noncompliance: False Claims Act
  • Overpayments
  • Best Practices and Resources

Suggested Attendees

  • Practice administrators, CEOs, COOs, CFOs
  • Compliance Officers
  • Healthcare CPAs
  • Revenue Cycle managers
  • Billers
  • Licensed Providers
  • Physicians and APPs
  • Office Managers
  • Billing Staff
  • Medical Auditors
  • Practice Managers
  • Auditors
  • Billing Companies
  • Clinic Owners
  • Chief Quality Officers
  • Senior Internal Auditors
  • Directors of Compliance
  • Regulatory/ Risk Officers
  • Government Employees
  • General Counsel
  • Compliance Attorneys

About the Presenter

Amanda Waesch has experience of 18 years and operates a national healthcare practice and is licensed in both Ohio and Florida. She primarily focuses her practice on healthcare, employment law, corporate law, and healthcare litigation and advises all types of employers, in particular healthcare providers, including, hospitals and physicians, on various matters.

She also chairs the firm’s litigation team that is primarily responsible for handling all reimbursement audits and appeals for her firm’s healthcare clients and heads up BMD’s Provider Relations, Audit, Appeals, and Negotiations Unit (PRAAN) which handles all-payer audits, appeals, overpayments and payment extrapolations.

Snippet From Our Previous Session

Course Content

You can access all the webinar materials after successful payment

  • Webinar Link + Handouts PDF
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