2018 CMS Guidelines for Physician Supervision & Incident-To Compliance

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Ensure You’re Properly Interpreting ‘Incident-To’ for Physicians and Hospitals

The phrase “incident-to” is used in two very different ways in the Social Security Act (SSA).  For physicians and practitioners, it refers to “incident-to billing”—that is, physician coding and billing for subordinate staff services. For hospitals, the phase refers to “incident-to services”—that is, the major benefit category for hospitals under the Medicare program. Hospitals are paid for services that are incident-to services provided by physicians. Confused? You’re not alone.

Untangle the difference between incident-to billing and incident-to services, and get your compliance ducks in a row: Join healthcare consultant Duane C. Abbey, Ph.D. for an in-depth examination of incident-to interpretations, how to comply with both concepts, and how to fully understand the interplay between them. He will also explain how to apply the terms to special situations, such as for Critical Access Hospitals (CAHs) and Rural Health Clinics (RHCs).

Session Objectives

This session will answer several pressing questions:

  • Why does CMS frequently refer to incident-to services?
  • What does incident-to really mean?
  • How does incident-to relate to hospitals versus physicians?
  • What are the rules and regulations surrounding incident-to services?
  • Are there differences between physician clinics and hospitals relative to physician supervision?
  • How does this issue relate to the 3-day payment window?
  • How do physician supervision and incident-to relate to the provider-based rule?
  • How do physicians use the incident-to process for billing?
  • Are there compliance implications for physician supervision and incident-to?
  • How does incident-to apply to CAHs and RHCs?

Session Highlights

This information-packed presentation will cover:

  • Incident-to billing for physicians
  • Hospital payment relative to incident-to physician services
  • Physician supervision for both physicians and hospitals
  • Hospital benefit categories under the SSA
  • Compliance impacts of incident-to in multiple situations
  • Incident-to as it applies to recently changed physician supervision requirements
  • Incident-to physician services in the provider-based clinic setting
  • Incident-to as it applies to specíal situations (e.g., 3-day payment window, RHCs, and telemedicine)
  • The evolving rules for supervision
  • The non-enforcement of the supervision rule for CAHs and RHCs
  • Case studies that illustrate the intricacies of incident-to compliance

Session Agenda

  • Objectives of physician supervision and incident-to services
  • Case study
  • Classifying issues
  • How to address the physician supervision issue(s)
  • Preliminaries to physician supervision and incident-to services
  • Provider-based rule – Background
  • Freestanding clinic billing
  • Facility or provider-based setting
  • Off-campus supervision obligation
  • Recent changes
  • Physician supervision changes for CY2010, CY2011 and CY2013
  • Services requiring only general supervision
  • Documentation
  • 3-day payment window

Who Should Attend

  • All personnel involved with compliance, coding, billing, and reimbursement
  • Financial analysts
  • Health information management personnel
  • Financial personnel
  • Patient financial services personnel
  • Chargemaster coordinators
  • Provider-based clinic and/or clinical operations personnel
  • Physicians
  • Practitioners

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
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