OIG Targets Incident-To Billing Compliance in 2025

The Office of Inspector General (OIG) recently added incident-to billing compliance to the Work Plan.? Based on this addition, the OIG will investigate whether Medicare Part B payments were made to healthcare providers in compliance with Medicare’s incident-to billing requirements.? This targeted inclusion to the Work Plan signals the OIG’s increased scrutiny of how healthcare providers interpret and report incident-to billing, raising the stakes for compliance and billing accuracy.

Incident-to billing allows certain services provided by non-physician practitioners (NPPs), such as nurse practitioners (NPs) or physician assistants (PAs), to be billed under a supervising physician’s National Provider Identifier (NPI) number when certain requirements are met.? Incident-to billing never applies to new patient encounters and cannot be utilized to circumvent the provider enrollment process within the Medicare program. ?When the incident-to billing criteria are met, Medicare reimburses the services at 100% of the Medicare Physician Fee Schedule (MPFS) rather than the 85% allowed for NPPs.? The requirements for incident-to-billing are complex and nuanced and often widely misunderstood by healthcare providers.

The OIG’s target of incident-to billing compliance stems from concerns about potential overbilling, overutilization, misapplication, and the financial impact on the Medicare program. Misuse or abuse of incident-to billing can lead to significant overpayments, fines, and potential civil or criminal liability.

Here are 5 steps to evaluate incident-to billing compliance within your organization:

1.????? Review Internal Policies: Ensure your organization has clear policies for incident-to billing compliance that align with Medicare requirements.

2.????? Educate and Train Providers and Staff: Train physicians, NPPs, and relevant staff on the rules, supervision requirements, and documentation requirements for incident-to billing.

3.????? Audit Clinical Documentation: Conduct regular audits of incident-to claims to identify and correct errors before they lead to overpayments or investigative scrutiny.

4.????? Self-Report Overpayments: Healthcare providers are required to self-report any identified overpayments. Healthcare providers are also required to conduct a full investigation of the lookback period involved to determine the total amount of overpayments if this billing practice was longstanding.

5.????? Seek Legal or Compliance Expertise: Consider consulting with healthcare compliance experts or healthcare attorneys to verify that your billing practices are compliant with Medicare incident-to billing requirements.

The OIG’s addition of incident-to billing to its Work Plan serves as a stark reminder of the importance of meticulous compliance in healthcare billing. ?As the agency sharpens its focus, healthcare providers should take this opportunity to review their processes, strengthen oversight, and ensure their claims withstand scrutiny.?

By adding this topic to the Work Plan, the OIG is effectively putting healthcare providers on notice that incident-to billing is a high priority fraud, waste, and abuse (FWA) target.? Compliance isn’t just about avoiding overpayments or penalties, but also safeguarding the integrity of your revenue and the healthcare reimbursement system at large.