Wiki Billing ASC charges under physician

[terridiaz]

Hi I have a few questions... I have never billed for ASC, I work for plastic surgeons and all of our cosmetic surgery patients are done in our Quad A surgery center. Any insurance surgery patients are done at the hospital because our surgery center isn't credentialed any insurance companies. We are working with a company on trying to work out a billing platform to do insurance cases in our surgery center. They are telling me that we don't need to have our surgery center credentialed with the insurance companies because they will bill out all charges under the physician, who is credentialed. I am questioning this because when you call for a prior auth the first question they ask is the location.
Also we have the NPI for our office, do we share this NPI with our surgery center (they are in the same space) or do we need to get our surgery center their own.

Any input is welcome and appreciated.

Thanks,

Terri

 

[capricew]

Hi I have a few questions... I have never billed for ASC, I work for plastic surgeons and all of our cosmetic surgery patients are done in our Quad A surgery center. Any insurance surgery patients are done at the hospital because our surgery center isn't credentialed any insurance companies. We are working with a company on trying to work out a billing platform to do insurance cases in our surgery center. They are telling me that we don't need to have our surgery center credentialed with the insurance companies because they will bill out all charges under the physician, who is credentialed. I am questioning this because when you call for a prior auth the first question they ask is the location.
Also we have the NPI for our office, do we share this NPI with our surgery center (they are in the same space) or do we need to get our surgery center their own.

Any input is welcome and appreciated.

Thanks,

Terri

First of all, your ASC should have its own NPI. It is technically a separate entity and you cannot bill ASC claims under the physician.

When you bill for the ASC - you are billing for the ASC only and all the supplies and equipment and staff required to staff it. This bill will be submitted on the UB-04 (facility claim form) with place of service code 24.

You will also bill the doctors professional fee on a HCFA-1500 but the place of service will be 24 as well.
You do not have to be credentialled with the various insurance companies as they will pay you at out of network rates which means a higher out of pocket cost for your patients. Your facility should be certified though through an accreditor such as AAAHC or the Joint Commission. (just a couple I know of)

So that being said, since you own a clinic and a surgery center whenever you do surgery in that center two claims need to be sent - one for the facility and one for the physician and both under place of service 24.

Hope this helps-feel free to contact me with any other questions

Caprice Walder, CPC