Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 55

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

“Incident To” The Shortest Way to Disaster

Many compliance and management companies say that a compliant avenue to increasing business is to work with non-licensed staff in an “incident to” scenario. This means that a non-licensed person is applying the e-stim pads and turning on the machines, in addition to applying the hot or cold packs. These are simple tasks that you can train a junior high school kid to do. In addition, many doctors often have aides working with patient’s 1-on-1 and are billing for 1-on-1 services with the doctor or therapist directly supervising in an “incident to” scenario. There are a litany of other services that an aide, or non-licensed person can perform in an office.


With that being said, I am also a compliance and management person, expert, grand poobah, etc. The difference is that I am also a doctor who has had to answer these same questions in my personal practice and I have, am and will be representing doctors as expert nationally who have to defend themselves against these and similar issues. The short version, I have insight that very few do in the industry.


To give you a concise, accurate and safe description of how to practice, do not practice in the “incident to” scenario. The federal standard is that “incident to” is non-allowable. Every state board that I have inquired does not allow “incident to.” Medicare does not “incident to” and most insurance companies do not allow “incident to.” In fact, Blue Cross in Illinois just came out with a bulletin this past month explaining the perils of “incident to services,” should they find the doctor practicing in that paradigm. The licensed individual who touched the patient is the person that the service should be billed under, with that person’s name on the SOAP note and HCFA. No one else should touch the patient in performing services that are meant to be performed by a licensed professional.


One doctor shared with me recently that “no one will ever find out,” so what’s the big deal? The truth, the carriers do find out, as they send investigators directly to the patient’s homes and scare the daylights out of their insureds, getting any and all information that is required to prosecute you. The answer is not to attempt to stay under the radar; the answer is to do it right without compromise. It takes a bit more work and lots of management in your practice, but doing any service compliantly is possible and does not have to jeopardize your volume. There are many things a non-licensed person can perform in an office, but that is for a different conversation.


A compliance audit needs to be done to ensure that your SOAP notes accurately reflect the services performed by that licensed person. If you haven't gotten one, again you are leaving yourself, your practice and your family exposed unnecessarily. Be wise, be pro-active and be economically smart by spending pennies to ensure you do it right instead of dollars trying to fix it. Call Dr. Schonfeld at 516-695-7732.




As a note, the last 3 doctors who were in trouble that called me, all stated they should have taken my advice and been in control of the audit instead of having to react to the insurance company's auditors! If you have not been in compliance, you still need an audit showing that you have fixed those issues. For those of you who haven’t been in compliance, we need to have a conversation, so that I can assess the specific action you need to take. Please call me immediately.

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