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MedPAC recommends Congress require APRNs and PAs to bill Medicare directly for patient visits. This would eliminate "incident to" billing, an option dating back to when advanced practice registered nurses (APRNs) and physician assistants (PAs) could only bill Medicare under the payment code of a supervising physician. Medicare billing rules have since changed, permitting APRNs and PAs to submit claims under their own billing codes. But a significant number of outpatient services provided by APRNs and NPs continue to be billed as "incident to," resulting in Medicare paying at 100% of the physician fee schedule (PFS) since there's no way to tell from the bill who did the work. This increases costs for the Medicare program and its beneficiaries since Medicare pays only 85% of the PFS when billed directly by APRNs and PAs. Eliminating the outdated "incident to" billing option would have no effect on the way care is delivered, according to the Medicare Payment Advisory Commission (MedPAC). In 2017, 212,000 NPs and PAs directly billed Medicare, a twofold increase since 2010.