OIG Report Regarding Suggested Revisions to "Incident to" Rule
On August 5, the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) released a report entitled Prevalence and Qualifications of Nonphysicians Who Performed Medicare Physician Services.
OIG made several recommendations to the Centers for Medicare & Medicaid Services (CMS) regarding revisions to the “incident to” rule:
- “Physicians who do not personally perform the services they bill to Medicare ensure that no persons except (1) licensed physicians personally perform the services or (2) nonphysicians who have the necessary training, certification, and/or licensure, pursuant to state laws, state regulations, and Medicare regulations, personally perform the services under the direct supervision of a licensed physician.” Under current Medicare guidelines, “direct supervision” means that the physician must be in the office suite, but not necessarily in the room where the services are being provided. (Medicare Benefit Policy Manual, Chapter 15, Section 220)
- “CMS should take appropriate action to address the claims for services that we detected that (1) were billed by physicians and performed by nonphysicians that were, by definition, not ‘incident to’ services and (2) were for rehabilitation therapy services performed by nonphysicians who did not have the training of a therapist.” Current Medicare law requires physicians to hire occupational therapy practitioners who have completed their education, fieldwork, and certification through the National Board for Certification in Occupational Therapy (NBCOT).
- “CMS should require that physicians who bill services to Medicare that they do not personally perform to identify the services on their Medicare claims by using a service code modifier. The modifier would enable CMS to monitor claims to ensure that physicians are billing for services performed by nonphysicians with appropriate qualifications.”
These are recommendations only, provided by the OIG to CMS. CMS concurred with the first two recommendations, but not the third. “These are issues AOTA is continually monitoring,” said Christina A. Metzler, AOTA’s chief public affairs officer. “For the benefit of the client especially, we believe only qualified, licensed practitioners should be performing occupational therapy. This is an issue that AOTA continues to fight for on a regular basis.”
Read AOTA’s previous comments regarding the “incident to” rule.