Incident-To/Non Incident-To Billing NPP (Mid-Level)

Incident-To/Non Incident-To Billing NPP (Mid-Level)

Non-Physician Practitioner (NPP) and Mid-Level Provider are interchangeable terms.

Incident-To Billing allows NPP (Mid-Level) Providers to report services as if they were performed by a Physician.
  1. NPP (Mid-Level) visits are typically reimbursed at a lower rate than the professional amount.
  2. The advantage of billing Incident-To is that the visits are reimbursed at the full professional rate.
  3. CMS Guidelines must be followed precisely. For more information, use this external link: Incident-To Billing Requirements-AAPC.)

What is Incident-To?

  • Incident-To Visit: The PA (NPP-Mid-Level Provider) sees a Patient for an Established Diagnosis follow-up visit.
  • Non Incident-To Visit: PA sees a New Patient or an Established Patient for a new problem.
  • The PA (NPP) must be credentialed under the GROUP NPI

How is Incident-To/Non-Incident-To handled in Charge Entry?

  • Incident-To: The NPP (Mid-level) is the Rendering Provider; the Supervising Provider is the Billing Provider and the Supervising.
  • Non-Incident-To: The NPP (Mid-level) is the Rendering Provider AND the Billing Provider, the Physician is the Supervising Provider.


The Provider is Rendering Only

Limiting the Provider to Rendering Only is set up on the Modify Provider screen in the Billing/Rendering Provider Library.

  1. Billing Status: Select Rendering Only from the dropdown.
  2. The new field, Default Billing opens.
  • If the NPP (Mid-level) always works under a specific provider, select that Provider.
  • Skip this step if the Billing Provider is not always the same Billing Provider.


Modify Charge Screen

On the Modify Charge screen:

  • A Validation Warning (hard stop) will display, if the NPP (Mid-level) is entered in the Billing field.
  • After the NPP (Mid-level) is selected, the Billing Provider will auto-populate based on the setting in the Billing/Rendering Provider Library.
  • The User can override the Billing by entering or selecting a different Billing Provider.
  • If the Charge comes from the Clinical Documentation:
  • The Client should map the NPP (Mid-level) to him or herself.
  • The Charge should reflect the correct Billing Provider based on the Library setup.
  • Check to be sure this is populating correctly.
  • The ANSI output
  • The Billing Provider will be sent in 2310AA.
  • The Rendering Provider will be sent in 2310B.


NPP vs Mid-Level

An NPP (formerly called a Mid-Level Provider) is a Non-Physician Practitioner.

  • Physician Assistant (PA)

  • Advanced Practice Registered Nurse (APRN)

    • Nurse Practitioner (NP)

    • Certified Nurse Midwife (CNM)

    • Clinical Nurse Specialist (CNS)

    • Pediatric Nurse Practitioner (PNP)

    • Family Nurse Practitioner (FNP)

  • Clinical Psychologists

  • Clinic Social Workers

  • Physical and Occupational Therapist

  • Speech Pathologists

  • Optometrist


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