DecisionHealth, DecisionHealth - 2011 Issue 6 (June)

Ask a NPP Report Expert: Dealing with incident-to denials after an audit

We have a PA-C working in our office. Claims for this NPP are billed incident to our physician. On a recent audit of these, the auditor stated the services rendered did not meet the criteria for incident to billing, as the PA-C was dealing with "new" problems, not outlined in the physician’s plan of care. When I look at the PA-C's note, I see a routine follow-up for chronic conditions. Are we missing something these auditors are looking for? 

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