OIG Report on Qualifications of Nonphysicians Performing "Incident To" Services

In a report issued on August 5, 2009, the OIG examined days that Medicare allows more than 24 hours of services billed by a single physician and sought to identify the services physicians bill to Medicare but do not perform personally and the qualifications of nonphysicians performing "Incident To" services.  The OIG found that: 

1.               When Medicare allowed physicians more than 24 hours of services in a day, half of the services were not performed personally by a physician; and

2.               Unqualified nonphysicians performed 21 percent of the services that physicians did not perform personally. 

The OIG recommended that CMS revise the "Incident To" rule to ensure nonphysicians have the appropriate licensure, certification and/or training required by state law, physicians who bill services to Medicare that they do not personally perform use a service code modifier and address claims that were not by definition "Incident To".  See OEI-09-06-00430.