TMA Urges UHC to Scrap Effective Ban on “Incident-to” Billing
By Joey Berlin

After earning one delay from UnitedHealthcare (UHC) on a concerning policy change on “incident-to” billing, the Texas Medical Association is making a last-ditch effort to urge UHC to scrap the new policy entirely – and prevent an ill-timed 15% cut to payments.

Incident-to billing allows practices in Medicare and some commercial plans to bill insurers for services performed by nonphysician practitioners (NPPs) at the full payment rate for physicians, as long as certain requirements are met. Incident-to billing is a booster for access to care, allowing physicians and NPPs to collectively see more patients through collaborative agreements.

But starting this Saturday, May 1, UHC will require nurse practitioners, physician assistants, and clinical practice nurses to use their own National Provider Identifier (NPI) number when billing, which in some cases could lead to a 15% payment reduction for those services.

In a letter Tuesday to United executives, TMA urged UHC to rescind that change permanently, effectively saying the timing couldn’t be worse.

“This policy change, implemented during a public health emergency, is causing both confusion and financial concern within physician practices,” TMA President Diana Fite, MD, wrote. “We urge UnitedHealthcare to implement a policy that bolsters physicians’ ability to collaborate with other health care professionals to provide team-based, patient-centered care.”

United’s policy change, first announced in late 2020, prompted TMA to conduct a survey of both member and nonmember Texas physicians on their incident-to billing activity. Responding physicians, on average, employ two nurse practitioners and one physician assistant, and nearly two-thirds said they bill incident-to when clinically appropriate.

Most respondents contract with up to seven different payers, TMA wrote to UHC, and a billing change by one payer “unnecessarily complicates the practice of medicine and places additional administrative burdens on practices’ billing staff. Thus we urge UnitedHealthcare not to deviate from established medical billing practices used by Medicare and others.”

Also, the TMA survey found, “physicians report the ability to treat an additional median count of 50 patients a week as a direct function of working collaboratively with nonphysician practitioners under incident-to arrangements. Ending incident-to billing arrangements threatens these patients’ access to physician-led, team-based care.”

TMA asks United to instead provide education to both physicians and NPPs on incident-to billing, in which the health plan would make 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 his or her own NPI.”

United originally planned to implement the new policy on March 1, but delayed it two months after TMA raised concerns in a previous letter in late February.


Last Updated On

August 05, 2021

Originally Published On

April 29, 2021

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