The patient calls requesting an additional appointment which the LCSW can accommodate. It is not an across the board requirement for all uses of these modifiers. Search for medications covered by Cigna plans. Telehealth Services. Billing of Mental Health Services: Incident to Billing Call Customer Service at the number on your Cigna ID card. This allows them to establish a plan of care or treatment for each problem identified. We have a group contract. When supporting documentation is indicated on an electronic claim submission, the supporting documentation can be mailed to Cigna address on the back of the patient identification card. Medicare is not prescriptive regarding what a change in a plan of treatment entails, so it will be important for organizations to establish the type of changes requiring physician involvement; e.g., a NP wants to prescribe a different medication for a patient or a LCSW decides their patient would benefit from eye movement desensitization and reprocessing (EMDR) to help treat a history of trauma. The patient is diagnosed with depression and post-traumatic stress disorder. NPs, PAs and clinical nurse specialists who were required to bill under their own NPIs and not incident-to the physician services prior to August 1, 2021, limiting reimbursement of their services to 85% of the physician fee schedule, will need to resubmit a corrected claim to be eligible to be paid at the physician rate. Shared services represent the model that many physicians would like to use everywhere in working with NPP practitioners. Medicare only permits incident to billing for certain patients in non-institutional settings. Typically the NPPs documentation is more detailed than that of the physician, but the physician should document the clinically relevant encounter with the patient and then tie his or her note to the NPPs. WebFor behavioral health providers, incident to is an attractive option because it increases patient access to services since practitioners without a Medicare billing number, or who are not recognized by Medicare, but also not excluded, can provide care and bill under the supervising physician. Unless otherwise noted, the following medical coverage policies were modified effective April 15, 2021: Balloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation (0480) Modified. Currently, there are two ways in which to bill Medicare for Non-physician Providers (NPP) services: direct (under the NPP`s name and NPI) and incident to (under supervising physician`s name and NPI). The level of the service is determined by combining elements in both notes to select the level of the service. a listing of the legal entities This summary is only a resource to assist in the billing process. Web24 example, Medicares incident to billing rules allow payment under the physician fee schedule for 25 services provided by a non-physician provider as long as the services are related to treatment for a 26 condition originally identified by a personal interaction between the patient and the physician, and See comment for policy | By Mastering Insurance for Mental Health Professionals | Facebook. Because the physician made the ultimate decision, this visit and future visits can be billed under the name/NPI of the supervising physician since the plan of care remained the product of the physicians decision-making. Medicare Benefit Policy Manual. The patient is seen for weekly psychotherapy by an LPC. Private payers typically approach billing for NPPs one of two ways: In many markets, commercial insurers, such as Aetna, Cigna, BCBS, 1199, UHC, Fidelis and Emblem Health enroll and credential NPPs, however not all commercial insurers follow Medicare incident to guidelines. Make sure claims have all required information before submitting. 1 0 obj This information about reimbursement methodologies and acceptable billing practices may help health care providers bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information. According to Medicare policy, In order to submit incident to billing the following criteria must be met: Please note that simply co-signing NPPs note, briefly meeting the patient or co-visiting do not meet the requirements. Certain non-physician practitioners (NPP) also provide services under incident to such as a physician assistant (PA), nurse practitioner (NP), clinical nurse specialist (CNS), certified nurse-midwife (CNM), licensed clinical psychologist (CP) and licensed clinical social worker (LCSW). Incident to Billing Medical Billing Group The physician must see established patients for their first visits for any new problems. Although incident to is a Medicare concept, non-Medicare payers may or may not follow Medicares rules for incident to. Be sure to contact your Medicaid and third-party payers regarding their rules for billing incident-to services and have their position in writing. This information does not replace the advice of a doctor. To bill for the NPP, the physician must have seen the patient first at a previous encounter and established the plan of care. Incident To The organization is then reimbursed at 100% of the physician fee schedule, as long as the guidelines are followed. 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