July 1, 2013 Departments

Policy Analysis: Federal Report Targets 'Incident To' Billing

Audiologists may be audited if they bill Medicare hearing and balance diagnostic services under a physician’s name and identification.

Audiologists who bill "incident to" a physician for certain services may be subject to audits, according to a report from the Office of Inspector General of the U.S. Department of Human Services.

The OIG's "Work Plan for Fiscal Year 2013" recognizes that many types of services provided in 2009 were inappropriately billed to Medicare. One of those categories is "incident to" billing—services that are billed by physicians but performed by nonphysicians.

Although the OIG's main concern focuses on unqualified nonphysicians, it is also assessing Medicare's ability to monitor "incident to" billing. OIG will pull medical records as necessary to determine appropriate billing practices.

The OIG may audit medical practices that provide audiology services if investigators believe that practice is in violation of two rules in particular:

  • A physician may not bill for hearing and balance diagnostic services under his or her National Provider Identifier, but instead must list the audiologist—and the audiologist's NPI—as the rendering provider when the audiologist performs the service. Physicians may bill "incident to" for rehabilitation services, nerve conduction tests and intraoperative monitoring provided by audiologists.
  • A physician must be in the office suite when services are rendered by technicians and billed "incident to" the physician. Medicare does not allow audiologists to supervise technicians or unlicensed personnel performing hearing and balance services.

The reason for the "incident to" restriction is related to the nature of the Medicare audiology benefit. Under Medicare, audiologists may bill only for hearing and balance diagnostic services. According to a 2003 policy, these services may not be billed as "incident to" a physician when provided by licensed audiologists.

In 2008, Medicare further enforced this policy by requiring all audiologists who practice in private or group practice—including physicians' offices—to obtain an NPI. The Medicare Claims Processing Manual (Section 30, Chapter 12), specifies that diagnostic hearing and balance services require the NPI of the performing audiologist, and that "Physicians and NPPs [nonphysician practitioners] may not bill for these codes when an audiologist has furnished the service."

Audiologists who perform nerve conduction tests appropriately bill these services "incident to" a physician, as Medicare does not allow audiologists to bill for them. However, the OIG report has identified electrodiagnostic testing—specifically needle electromyogram and nerve conduction tests—as an area of overuse and a potential area of vulnerability in the Medicare program. OIG may, therefore, audit medical practices that bill these tests at high rates.

For the complete report, visit the OIG website. For information on Medicare enrollment, visit the ASHA website.

Lisa Satterfield, MS, CCC-A, is ASHA director of health care regulatory advocacy. lsatterfield@asha.org

cite as: Satterfield, L. (2013, July 01). Policy Analysis: Federal Report Targets 'Incident To' Billing. The ASHA Leader.


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