The Office of Inspector General of the Department of Health and Human Services has just released a report examining problems with incident to billing by physicians, and seeking restrictions on the use of that billing arrangement. The report, titled "Prevalence and Qualifications of Non-Physicians Who Performed Medicare Physician Services" was posed by the OIG on August 6, 2009. The OIG believes that incident to services may be vulnerable to over-utilization and may put beneficiaries at risk of receiving services that do not meet professionally recognized standards of care. For the audit, OIG reviewed the data for the first quarter of 2007 and identified all the days during which Medicare allowed services for physicians in a single day that exceeded 24 hours of physician work time, which would be measured by RVUs. They selected 250 of these "physician day combinations" and requested that the physicians identify who performed each service that Medicare allowed on those selected days, using a variety of audit and physician contact techniques. OIG concluded that unqualified non-physicians performed 21% of the services that physicians did not perform personally.
OIG recommended as follows:
1. CMS should see revisions to the incident to rule and require that physicians who do not personally perform the services they bill to Medicare ensure that no persons do perform such services except non-physicians who have the necessary training, certification, and/or licensure in accordance with state laws and regulations.
2. CMS should require physicians who bill incident to services to identify the services on their Medicare claim forms by using the service code modifier.
3. CMS should specifically address claims for services detected and billed by physicians but performed by non-physicians that were "not incident to" and were for rehabilitation therapy services performed by non-physicians without the training of a therapist.
