Loansforlife

2+ Year Member
Apr 1, 2015
32
9
Status
Psychologist
So in my current downtime of waiting for insurance credentialing to trickle in I am helping review the billing policies and procedures for our Psychology department.

A current concern brought by our risk management guy is regarding medicare and proper billing when using "Incident to" provisions:
1) A clinical psychologist who has a Medicare number can have another provider provide services billed "incident to" the psychologist provided the psychologist first establishes treatment necessity and a plan and supervision requirements are met. However it is vague in terms of "who" the rendering provider is. Can a LMHC provide the treatment services after a psychologist does the initial evaluation?

Medicare recognizes psychologists and LCSW's as being able to bill and use the "incident to" provision. But what about who "renders" the actual services? LMHC, LMFT's, Post-docs?

Anyone have experience with this? It seems Medicare verbiage leaves a lot open to interpretation, and there is lots of conflicting interpretation.
 
Apr 25, 2014
1,679
1,025
Florida
Status
Medical Student
Yes, Psychologists can bill "incident to" but the rules vary by Medicare and insurance company. Medicare clearly allows it, but you'll have to follow their guidelines, which can be vague. The person who renders depends on the particular services. The rules are pages long, but can be found on the cms site.
 
Mar 24, 2014
4,393
3,841
Rural Area Medical Facilty
Status
Psychologist
My wife (she works in medical billing) would be able to find that out. My understanding is that the only way to really know for sure is to submit the claim and see what comes back. She has tried to explain some of the procedures and terminology to me, but after about ten minutes I get the same glazed look that she gets when I get too carried away with explaining really fascinating psychology stuff to her.