Quantifying Indirect Billing Within the Medicare Physician Fee Schedule.

ABSTRACT:

Importance

Under certain circumstances, advance practice clinicians (APCs), such as physician assistants and nurse practitioners, can bill Medicare directly or indirectly (ie, incident to the services of a physician). With indirect billing, the submitted claim states the care was provided by the physician, and the reimbursement is higher.

Objective

To quantify volume and spending on office-based encounters billed indirectly in the Medicare program.

Design, setting, and participants

This cohort study used Medicare fee-for-service and Medicare Advantage claims data to identify indirectly billed APC services. To do so, office-based Medicare Part B claims (ie, clinician services) were linked to Part D claims for prescription drug fills. Because the latter contains the pre

SUBMITTER: Mulcahy JF 

PROVIDER: S-EPMC11992606 | biostudies-literature | 2025 Apr

REPOSITORIES: biostudies-literature