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Critical Access Billing Question


Best answers
The critical access hospital where I work is billing with Method II.
they have a wound care center and the doctor there is now an employee of the hospital.
He has agreed to reassignment of his billing rights to the CAH and agreed to the optional payment method HE/SHE will not be billing for any professional services provided.
However, the CAH wants to bill on the 85X the facility TC say like a debridement and then under the revenue center of 0960 professional clinic bill for the debridement.
I went to the Medicare Pub regulations for CAH posted on the CMS website and found language:

Payment to the CAH for each outpatient visit (reassignment billing) will be the sum of the following:
For facility services, not including physician or other practitioner services, payment will be based on 101 percent of the reasonable cost for the outpatient services less applicable Part B deductible and coinsurance plus:

Show the professional services separately, along with the appropriate HCPCS code (physician or other practitioner) in one of the following revenue codes- 096X, 097X or 098X.

so I take it as the facility can bill on one 85x form the same code twice one for the TC of the CAH facility and the same code for the professional fee.

Example: revenue center 0510 CPT 97594 Debridement for the technical (facility charge) and revenue center 0960 CPT 97594 debridement for the professional charge for the procedure.