Question

When a patient is seen by a nurse practitioner, the visit can be charged to Medicare using "incident-to" billing. If the criteria for this type of visit are fulfilled, then anticipated reimbursement is at what percentage of the physician rate?

a) 75
b) 80
c) 90
d) 100

Answer 1

If 'incident-to' billing criteria are met, nurse practitioner visits can be reimbursed at 100% of the physician rate by Medicare Part B.

Step-by-step explanation:

In the context of Medicare billing for services provided by a nurse practitioner, when the "incident-to" billing criteria are met, the anticipated reimbursement is at 100% of the physician rate. This indicates that the nurse practitioner's services, when performed under the direct supervision of a physician and fulfilling all other 'incident-to' criteria, are billed as if the physician provided the services directly. Such an arrangement allows for full reimbursement from Medicare Part B, which is significant given that Part B covers health-care costs such as physician services, medical tests, and outpatient visits. For the patient, Part B requires a monthly fee, deductibles, and copayments, with the government contributing around three-quarters of the overall costs.