Wiki Facility billing for office visit????

[mfranks]

One of the orthopedic Physicians that I work for is wanting to know if his office can bill both a Facility and professional charge for patient visits. I have never heard of a physicians office billing for both and can not find anything online that gives any advice. Anybody know if this can be done? In my opinion it shouldn't be.

 

[mitchellde]

when the physician office bills the visit with the POS of 11, then the reimbursement will contain booth the professional as well as the facility component. When you have a visit in the outpatient facility setting then you use the 22 POS and the provider is paid the professional component and the facility is paid the facility component.

 

[nyyankees]

when the physician office bills the visit with the POS of 11, then the reimbursement will contain booth the professional as well as the facility component. When you have a visit in the outpatient facility setting then you use the 22 POS and the provider is paid the professional component and the facility is paid the facility component.

I would assume that Article 28 practices are billed out as POS 22 which in turn allows both portions of the E/M to be billed?

 

[mitchellde]

Yes but the facility should bill the facility component on a ub and using the facility tool to assess the level of E&M. The facility E&M is never assessed using physician guidelines

 

[Monika Liddle]

Facility/Office Billing

In order for an office to bill both the facility/office charge the office must get credentialed as a Provider Based Facility. You will need to look at the Federal Register to get the criteria that must be met.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/a03030.pdf