If a provider was out of the office, can the service be billed to Medicare?

The situation regarding billing Medicare when a provider is out of the office is governed by incident-to guidelines. These guidelines outline the conditions under which services provided by non-physician practitioners (such as nurse practitioners or physician assistants) can be billed under a physician's Medicare number as an extension of the physician's services.

Incident-to services can only be billed when a physician is present in the office and actively involved in the care of the patient. Therefore, if a provider is out of the office and another provider steps in without the proper supervision or without the established incident-to relationship, the services rendered cannot be billed under Medicare. This is because the specific requirements of supervision and the previous treatment relationship must be met for billing to be compliant with Medicare regulations.

In scenarios where a different provider covers for the absent provider, the ability to bill Medicare hinges on whether those services are rendered under an approved incident-to arrangement or if they can qualify under a different billing provision. However, in the absence of the supervising provider, services typically do not meet the necessary criteria for Medicare billing. This ensures that the integrity of the billing process is maintained and aligns with Medicare's policies.