title: Decoding incident-to and provider-based billing: ensuring payment and avoiding liability.
abstract: In this increasingly complex world of Medicare reimbursement, physicians must constantly review their billing practices to ensure compliance with all Medicare requirements. "Incident-to" billing and provider-based billing are two areas that present unique challenges for providers, especially those practicing in hospital-owned practices such as hospital outpatient departments. Both incident-to and provider-based billing limit providers' abilities to bill for and receive reimbursement in those practice settings. The Office of Inspector General's 2012 Work Plan Report identified both incident-to billing and place-of-service errors as two of the many areas for investigation and compliance efforts in 2012. This article focuses on identifying the unique point-of-service challenges presented by physicians practicing in hospital outpatient departments or hospital-owned clinics.
authors.affiliation: pshofstra@duanemorris.com
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Hofstra
authors.forename: Elinor L
authors.initials: EL
authors.lastname: Hart
mesh_terms: D003695:Delivery of Health Care / Q000331:legislation & jurisprudence / Q000458:organization & administration; D006801:Humans; D006278:Medicare / Q000331:legislation & jurisprudence*; D009817:Office Management / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D010044:Outpatient Clinics, Hospital / Q000331:legislation & jurisprudence / Q000458:organization & administration; D010350:Patient Credit and Collection / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D010824:Physicians' Offices / Q000331:legislation & jurisprudence / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence / Q000458:organization & administration; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D014481:United States