TMA Survey on the Impact of Ending “Incident-To” Payments

The Texas Medical Association (TMA) is concerned about recent moves by health plans to curtail the longstanding ability for practices to bill “incident-to” for services provided by nonphysician practitioners.

At the button below, you’ll find a short survey that TMA has put together to help them better understand the implications of a payer ending incident-to payments. If these changes are applicable to your practice, please take this survey by Friday, April 23. You may need to consult with your practice administrator to answer the questions. More details on changes to incident-to payments can be found below.

Many health plans pay at 100% of the physician rate when a nurse practitioner (NP) or physician assistant (PA) provides a service and the practice bills it as incident to a supervising physician. However, they pay at 85% of the rate when the service is billed under the NP’s or PA’s own National Provider Identifier (NPI).

UnitedHealthcare (UHC) is one such payer that has announced a policy, effective May 1, that would require nonphysician practitioners to bill under their own NPI. This policy change effectively cuts payments by 15% to physicians who employ nonphysician practitioners and who bill under incident-to arrangements. In a Feb. 26 letter to UHC, TMA urged it to “make it clear that physicians can continue to utilize advanced practice nurses and physician assistants under proper incident-to billing arrangements, even if the advanced practice nurse or physician assistant has their own NPI.”