[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-455192-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-455192-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","the-cost-of-indirect-billing-for-traditional-medicare-beneficiaries-research-summary","The cost of indirect billing for traditional Medicare beneficiaries - Research summary","","Advanced practice clinicians increasingly provide Medicare services, and these services can be billed directly or indirectly (“incident to”). Indirect billing shifts costs to Medicare beneficiaries through deductible and coinsurance cost-sharing, yet prior work lacked empirical estimates of the annual burden. Using 100% traditional Medicare fee-for-service claims, the study estimates beneficiary cost-sharing liability and identifies which beneficiary characteristics are associated with exposure and higher financial burden from indirect billing.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/the-cost-of-indirect-billing-for-traditional-medicare-beneficiaries-research-summary/455192/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/the-cost-of-indirect-billing-for-traditional-medicare-beneficiaries-research-summary/455192.png","ImageObject",300,407,{"name":42,"@type":43},"Indoniesian Boy","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"How is indirect billing different from direct billing for Medicare beneficiaries?","Question",{"text":63,"@type":64},"Advanced practice clinicians can bill Medicare directly at 85% of the Physician Fee Schedule rate, or bill indirectly (“incident to”) at 100% of the fee schedule rate. Indirect billing is associated with additional cost-sharing for beneficiaries through Medicare deductible and coinsurance.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What data and approach were used to estimate beneficiaries’ annual cost-sharing burden?",{"text":68,"@type":64},"The analysis used 100% of traditional Medicare fee-for-service claims, applying existing methods to identify office-based Physician Fee Schedule services provided by APCs and billed indirectly. It then calculated total annual cost-sharing liability as the sum of deductible and coinsurance liabilities, and estimated potential savings by using 15% of indirectly billed cost-sharing liability.",{"name":70,"@type":61,"acceptedAnswer":71},"What did the study find about the scale and potential savings in 2023?",{"text":72,"@type":64},"In 2023, beneficiaries accrued $682.9 million in cost-sharing liability for indirectly billed APC-provided services. If these services had been billed directly instead, cost-sharing liability would have been $102.4 million lower.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},455192,1790794537,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":111,"preview_page_count":4},962090760608,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","The cost of indirect billing for traditional Medicare beneficiaries  \nHannah T. Neprash 1, *, John F. Mulcahy2  \n1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, United States 2 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States *Corresponding author: Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE MMC 729, Minneapolis, MN 55455, United States. Email: [hneprash@umn.edu](hneprash@umn.edu)  \nKey words: Medicare payment policy; nurse practitioners; clinical workforce; patient out-of-pocket costs.  \nAdvanced practice clinicians (APCs) provide a growing share of services for Medicare beneficiaries.1 When caring for Medicare beneficiaries, APCs can bill Medicare directly and receive 85% of the Physician Fee Schedule rate for a service, or they can bill indirectly (ie, “incident to” the services of a physician) and receive 100% of the fee schedule rate. Indirect billing is costly to the Medicare program and existing research quantifies this.2 However, indirect billing also imposes a cost on Medicare beneficiaries, who frequently face cost-sharing based on Medicare reimbursement—and no empirical estimates exist to quantify this cost to beneficiaries. We analyzed traditional Medicare claims data to quantify the annual cost-sharing liability for Medicare beneficiaries and quantify characteristics of beneficiaries facing exposure to indirect billing and higher cost-sharing liabilities as result.  \nMethods  \nUsing 100% of fee-for-service claims, we applied existing methods to identify office-based Physician Fee Schedule services provided by APCs and billed indirectly to Medicare.1-3 In brief, these methods link prescription drug claims to claims for office services and rely on prescriber identifiers to identify indirect billing by an APC, before extrapolating patterns of indirect billing to non-prescription-linked encounters, in order to estimate overall prevalence and spending. We then calculated the total annual cost-sharing liability (the sum of deductible and coinsurance liabilities) for care provided by APCs and billed directly or indirectly. To identify potential savings from the elimination of indirect billing, we calculated 15% of all indirectly-billed cost-sharing liability.  \nTo test for beneficiary characteristics associated with exposure to any indirect billing and with a higher financial burden of indirect billing, we focused on beneficiaries with full-year enrollment in traditional Medicare who received any care from an APC in 2023. We first regressed an indicator for whether any APC-provided care was billed indirectly on beneficiary characteristics. Beneficiary characteristics of interest included age category, sex, race, dual eligibility for Medicare and Medicaid, rural location, and chronic condition count. We  \nnext focused on beneficiaries with >$0 cost-sharing liability for indirectly-billed services provided by APCs in 2023. We regressed the log of beneficiary-level total cost-sharing liability for indirectly-billed services on beneficiary characteristics. Taking the log of a skewed spending variable such as cost-sharing liability is standard practice for skewed spending variablesand results in an interpretation of coefficient as percent change. Both dependent variables relied solely on our subsample of prescription-linked encounters where we can observe indirectbilling directly, as our imputation method is imprecise at the beneficiary-level. The University of Minnesota institutional review board approved analyses, which were conducted using SAS version 9.4.  \nResults  \nOur sample included 50 843 425 beneficiaries enrolled in traditional Medicare between 2016 and 2023. Figure 1 shows annual cost-sharing liability for Physician Fee Schedule services provided by APCs, by billing status (ie, direct and indirectlybille","cbCailn5vZimYrNe","https://ap.wps.com/l/cbCailn5vZimYrNe","pdf",242287,"English","# Methods\n## Identify indirect billing and estimate annual cost-sharing liability\n## Regression analyses for beneficiary characteristics\n# Results\n## Total cost-sharing burden in 2023\n## Characteristics associated with exposure and higher burden","[{\"question\":\"How is indirect billing different from direct billing for Medicare beneficiaries?\",\"answer\":\"Advanced practice clinicians can bill Medicare directly at 85% of the Physician Fee Schedule rate, or bill indirectly (“incident to”) at 100% of the fee schedule rate. Indirect billing is associated with additional cost-sharing for beneficiaries through Medicare deductible and coinsurance.\"},{\"question\":\"What data and approach were used to estimate beneficiaries’ annual cost-sharing burden?\",\"answer\":\"The analysis used 100% of traditional Medicare fee-for-service claims, applying existing methods to identify office-based Physician Fee Schedule services provided by APCs and billed indirectly. It then calculated total annual cost-sharing liability as the sum of deductible and coinsurance liabilities, and estimated potential savings by using 15% of indirectly billed cost-sharing liability.\"},{\"question\":\"What did the study find about the scale and potential savings in 2023?\",\"answer\":\"In 2023, beneficiaries accrued $682.9 million in cost-sharing liability for indirectly billed APC-provided services. If these services had been billed directly instead, cost-sharing liability would have been $102.4 million lower.\"}]","The cost of indirect billing for traditional Medicare beneficiaries - Research summary | PDF",1790742332]