What are the requirements for indirect (incident to) reimbursement from Medicare?
Medicare calls billing and receiving payment under a physician’s name for services provided by an APRN “incident to” reimbursement. This means that the service: • Was furnished “incident to” the professional services of a physician, where the physician initiates the course of treatment and establishes the plan of care; • Was furnished under the direct personal supervision of the physician, which means that the physician must be present in the office/suite and able to see the patient when the APRN renders the service; • Was provided by an APRN who is an employee of the physician (or clinic); • Was medically necessary; • Is Medicare-covered; • Is commonly provided in a physician office/clinic; • Is billed under the physician’s name with the modifier “YR”. Direct personal supervision, as defined by CMS means that there must have been a direct, personal, professional service furnished by the physician to initiate the course of treatment. The service being performed by the non-physician pra
