NY Appeals Court Clarifies Who Can Bill Facility Fees

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  • February 25, 2015
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NY Appeals Court Clarifies Who Can Bill Facility Fees

What qualifies a healthcare organization to bill facility fees? Avanguard Medical Group, Woodhaven, New York, learned the answer the hard way.
The practice tried for years to collect facility fees from no-fault insurers for the use of its Brooklyn office, where office-based surgeries are performed. GEICO repeatedly denied their claims, and a court battle ensued.
The NY Court of Appeals ruled, Feb. 18, in favor of GEICO on the basis that only providers duly licensed under Article 28 of the Public Health Law are authorized to bill no-fault carriers for office-based facility fees.
It would be “improper,” the court said, to determine that a facility such as Avanguard is entitled to the same benefits as hospitals and ASCs, “when it is not subject to the significant regulatory burdens and costs of that article.”
A facility fee is a charge for the use of a medical facility and its staff and equipment. This fee is separate to the fee a qualified healthcare provider can charge for his or her services.
Source: Outpatient Surgery Magazine

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

No Responses to “NY Appeals Court Clarifies Who Can Bill Facility Fees”

  1. Mignant Henderson says:

    Hi I have some questions about facility fees in regards to ambulatory clinics in New York. My insurance was charged 23,000 for a termination of pregnancy for a under 6 week procedure. My dependent used my plan. My insurance payed I believe 12,000 dollars. A check was submitted in my name. When I asked my insurance should I send the check to the provider I was told no. Is this normal for a facility to charge $11, 100.00 for facility use. When paying with cash or a credit card is between $400 to 2.000? I found this bizarre. Can someone please direct me.