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OIG pushes for an incident-to modifier ... and CMS pushes back

You'll have to add a modifier to claims for services performed incident-to if the HHS Office of Inspector General has its way, but take heart. CMS is pushing back against this suggestion. As CMS officials put it, they "non-concur" with the recommendation.

The OIG is focused on compliance and patient safety, not making your life more difficult. In an inspection report the OIG released yesterday, the agency estimates that for the first three months of 2007, unqualified NPPs performed 21% of services billed incident-to. But the agency repeatedly stated that it wasn't certain what NPPs are doing when a practice bills their services incident-to because there's no way to track that information. It shouldn't come as a surprise that an agency tasked with making sure every partner in federal and state healthcare follows the rules doesn't like this kind of uncertainty.

An upcoming issue of the Non-Physician Practitioner Report will provide in-depth coverage of this report and what it could mean for NPPs.

By the way, the OIG doesn't have psychics on staff. Auditors gathered their data by looking at doctors who billed for more than 24 hours worth of services in a day, picked 250 at random and asked them to account for every service performed that day.

OIG Inspection Report

 

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Reader Comments (4)

Here is an idea.  Get rid of incident to all together and have whoever performed the service bill for the service.  That way there is no more hiding of services performed by NPPs behind the physician's name.

CMS thinks it would be difficult to implement. Here's the agency's response to OIG:

We non-concur with this recommendation as it is currently structured, not because we disagree with its underlying objective of increasing the available data on services provided "incident to". but because incidental services are often shared by physicians and staff, making definition of a service not "personally performed" operationally difficult. CMS will study the operational issues involved in adding code modifiers to services furnished exclusively by staff other than the physician identified as the rendering provider.

One question, why does CMS not concur?

mrscott@comcast.net

 

This is disturbing at so many levels!  I would hope that the OIG will do all that is necessary to stop this practice before a patient pays the price!

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