The ins and outs of "incident-to" reimbursement.

www.aafp.org / fpm ■ F A M I L Y P R A C T I C E M A N A G E M E N T ■ 23 IL LU ST R A TI O N B Y J O H N F R ET Z Nonphysician providers of many stripes now work in family practices. This includes a variety of midlevel providers, nurses and medical assistants, among others. One way Medicare recognizes these individuals for payment purposes is by reimbursing physicians for services provided “incident to” a physician’s care. As the use of nonphysician providers in family practices has evolved, it has become increasingly important to understand the incident-to rules. How can you afford not to? The reimbursement for a level-I established patient office visit according to the 2001 Medicare physician fee schedule is $19.89. If you provide even four such visits a day without billing for them, your practice could be losing nearly $400 per week, or approximately $20,000 per year.