In its June 2019 quarterly report to Congress, the Medicare Payment Advisory Commission (MedPAC) voted unanimously to recommend that Congress eliminate “incident-to” billing under Medicare and refine specialty designations for advanced practice registered nurses (APRNs) and physician assistants (PAs). The recommendation seeks to reduce Medicare spending and improve accounting and tracking of services rendered by APRNs and PAs.

“Incident-to” billing occurs when these practitioners or other auxiliary personnel perform a service but bill Medicare under a supervising physician’s national provider identifier (NPI). Such billing of services “incident to” physician services is currently permitted under Medicare if certain conditions are met, and results in payment at the physician’s fee schedule rate rather than 85 percent of the Medicare rate when billed under the APRN or PA’s NPI.

The report discusses a trend of the growing use of PAs and nurse practitioners (NP), the most common type of APRN. MedPAC further notes recent patterns suggesting that NPs and PAs are increasingly practicing in specialty fields, diversifying the variety of services they perform. According to MedPAC, the historical development and current status of “incident-to” billing rules do not reflect these growth trends in APRN and PA use.

MedPAC’s recommendation would require APRNs and PAs to bill Medicare directly, eliminating “incident to” billing. In addition, MedPAC also recommends that Medicare’s specialty designation for APRNs and PAs be refined. According to MedPAC, requiring these advanced practitioners to bill directly would better reflect the provision of care in practice, allow for better accuracy in valuation of quality and cost of services, and bring more clarity and accuracy to Medicare data. In the report, MedPAC also estimates that this recommendation would reduce Medicare spending “by $50 million to $250 million in the first year and by $1 billion to $5 billion over the first five years.”

If Congress were to act on these recommendations, it would have a significant impact on revenue and operations of the large number of physician practices that employ APRNs or PAs. The full MedPAC report can be found on the MedPAC website here.