Incident-To Rules Compliance: Still Tripping Up Providers

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Five Critical Components to Qualify For Incident-To Billing

Recent Medicare audit recoveries and settlements indicate that providers still have difficulty navigating the “incident to” rules. This directly impacts billing and payments for services performed on behalf of physicians, groups and facilities. In some cases, there may not be any alternative to billing a service as incident-to, or the other options will result in less reimbursements.

Further, failing the incident-to standards can sometimes result in fraudulent billing and self-referral law violations. For example, if a provider bills incident-to but knowingly fails to provide the proper level of supervision mandated for this billing option, false claim and Stark law allegations may follow. Likewise, failure to fully document incident-to compliance can also lead to serious trouble.

Expert speaker Wayne J. Miller, Esq. will discuss the rules of incident-to billing and provide examples of how it applies in particular disciplines, such as physical therapy, hospital outpatient care and complementary care. He’ll discuss lessons learned from recent cases. Also, Wayne will discuss key attributes of supervision and documentation requirements that must be met in order to avoid serious fraud and abuse or other violations.

Topics to be covered include:

  • Five critical components to qualify for incident-to billing
  • How the standards compare in offices and at hospital clinics
  • Where to find the most current and best resources for billing NPP services
  • Key attributes of supervision and documentation requirements
  • How to avoid serious fraud and abusè or other violations
  • Sweating the details: PT, complementary care
  • Related standards to meet under anti-kickback and Stark laws
  • Fixing incident to problems
  • Inappropriate documentation and direct billing
  • Lessons learned from recent cases
  • Examples & Questions

Who should attend

Hospitals, Physicians, Practice Managers, Medical Groups, Health Care Consultants and Medical Practice and Facility Executives


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About Our Speaker

Wayne J. Miller - Healthcare Compliance Expert

Wayne J. Miller, Esq., is a founding partner of the Compliance Law Group, Los Angeles, a law firm focused on health care industry legal compliance for clients nationwide. Wayne has practiced healthcare business and regulatory law throughout his 30-year career. His firm represents a wide range of healthcare industry clients throughout the nation. He is a frequent speaker for The Coding Institute national teleconferences on healthcare reimbursement, transactional and regulatory...   More Info
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