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Wiki ASC facility billing 2 separate dr. 2 separate procedures

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seslinger

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Can I get some imput?
We have drs. doing 2 separate surgerys, 2 separate sites. The commercial insurance such as Anthem pays then they take back there money usually on 1 of the cases. Then we would usually have to appeal the case. Is anybody doing these surgeries and not getting their money taken back and if so how are you billing them? With a certain modifier?

thank you, Sheila,CPC
 
Ginette, CPC

I have found, after speaking with various payers, and BCBS in particular, that they want us as an asc facility to file one claim for both dr's. They feel rightly so that the patient came to our facility one time in one day regardless of the number of procedures performed. This also eliminates the payer applying more than one facility co-pay, if applicable. Since we use a clearing house, I submit the top pay paying procedure, then amend the claim by hand at the clearing house level. It is a bit more work, but sure beats the extra time trying to get your claim paid correctly. And we usually do not see this scenario that often. Hope this helps.
 
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