Incident-to billing scrutinized under OIG 2012 Work Plan

The Office of Inspector General (OIG) released its Work Plan for 2012 last week, with heightened scrutiny on incident-to billing by nonphysician practitioners among its new and recurring goals outlined in the report.

In its 2012 Work Plan, the OIG stated that incident-to billing "may be vulnerable to overutilization and expose Medicare beneficiaries to care that does not meet professional standards of quality." According to Medscape Today, the OIG intends to determine whether incident-to claims have a higher error rate than ordinary ones, as well as assess the ability of CMS to monitor incident-to services, which are not identified as such on claims.

Although the OIG isn't concerned with the high volume of incident-to services billed to Medicare, it is taking a closer look at whether clinicians are qualified to deliver the services that they bill incident-to their supervising physicians, the article explained. In particular, the watchdog group is acting on a 2009 study that revealed that for 21 percent of the incident-to services performed, the nonphysicians did not have the required licenses, certifications, credentials, or appropriate training. In some cases, medical assistants performed complex skin surgeries for which they were not qualified.

In addition, the OIG says it will examine the extent to which physicians are opting out of Medicare, the safety and quality of care at ambulatory surgery centers, and the validity of Medicare payments to chiropractors.

To learn more:
- read the article from Medscape Today
- check out the OIG's 2012 Work Plan

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