Question
I want to know about "incident to" billing for VNGs. I have a Medicare and Medicaid numbers and they will bill my number for those patients but the ENT is not enrolled for some third party payers and the neurologist is. He present in the clinic during testing. I work in Missouri, does that make a difference? Can we bill the neurologist number for those other insurances? The billing person thinks that since I'm a licensed audiologist that we cannot.
Answer
Living in Missouri really makes no difference as to the answer I give. The premise of it all is that we are recognized by the government as qualified health care providers. Now, if we are not members of a third-party payor network then by rights we really should not see that patient. Now, that's in an ideal world. Everybody should bill under their own number and the situations where they are entitled to bill in the ideal world.
Now, I've been around long enough to know that the real world is not always the ideal world and incident two billing takes place by a physician in the office.
But, if that does happen I want to discourage it. But realistically, if that does happen, here is the requirement: The physician under whom your services are billed must be an active treating physician for that patient and must be the physician who requested those tests.
If that neurologist, in the case of this question, did not see the patient, was not actively involved in the evaluation and treatment of that patient, really had nothing to do with requesting the test, had never seen the patient, it would not be appropriate to use that physician's number to bill;in fact, that would come under the heading of fraud to do so.
Robert Fifer, Ph.D., is the Director of Audiology and Speech-Language Pathology for the Mailman Center for Child Development at the University of Miami School of Medicine. He is also an Audiology Online Contributing Editor in the area of Coding and Billing. He is the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee.
Editor's Note - The above is a partial transcript from the Coding and Billing QNA Live e-Seminar that was conducted on Audiology Online on June 27, 2007. (The recorded version is available here - Also the complete edited transcript is available here. The format of the session was different from most traditional presentations as we solicited questions ahead of time and also solicited questions during the event and had Dr. Fifer focus on answering those questions during the live session. We have published the transcript from the seminar in a semi-rough format to preserve the live feel from the session and to accelerate the publication timeline of this information to the Audiology Online readers. Submitted questions are bolded, followed by Dr. Fifer's response. Dr. Fifer is a frequent Contributing Editor for Audiology Online in this area, look for additional Coding and Billing QNA sessions on our home page in the near future. - Paul Dybala, Ph.D. - Editor
