Sheyla44
Contributor
Private OBGYN office performs their LEEP at a neighboring facility at their own expense. Can the private OBGYN office charge the patients insurance a facility fee? If so, what would be the CPT code? Please advise
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Wiki Facility fee charges
- Thread starter Sheyla44
- Start date
thomas7331
Guest
Most likely you cannot do this. You can only bill a facility fee if you are licensed, credentialed and enrolled with the payer as a facility provider.
But I'm not sure what exactly you mean in saying the practice is doing this 'at their own expense' - what expenses are being incurred by the practice? Is the practice paying the facility for the use of the space and the facility staff's time? This would be a very unusual, and possibly non-compliant, arrangement with a facility. The facility should be the one providing all technical costs involved in a procedure being performed on their site. The only expense the provider should be incurring is the professional service, unless the provider has a designated suite or office inside the facility for which they are responsible for all operational costs. If that is not the case but your provider is paying some of those expenses that the facility should be covering (i.e. use of equipment, drugs, supplies) then the provider should be seeking reimbursement directly from the facility itself.
But I'm not sure what exactly you mean in saying the practice is doing this 'at their own expense' - what expenses are being incurred by the practice? Is the practice paying the facility for the use of the space and the facility staff's time? This would be a very unusual, and possibly non-compliant, arrangement with a facility. The facility should be the one providing all technical costs involved in a procedure being performed on their site. The only expense the provider should be incurring is the professional service, unless the provider has a designated suite or office inside the facility for which they are responsible for all operational costs. If that is not the case but your provider is paying some of those expenses that the facility should be covering (i.e. use of equipment, drugs, supplies) then the provider should be seeking reimbursement directly from the facility itself.
mitchellde
True Blue
That’s entertaining... no you cannot charge a facility fee when you rendered services in a different location, or did I misunderstand the question? You must use the location address of where the procedure was performed as well.
Sheyla44
Contributor
Yes, the practice is paying the facility for the use of the suite and supplies. The practice does not have the equipment nor the space to perform the procedure, so they are in a contract with the neighboring facility (which is also a private practice) to perform LEEPs. So the provider is inquiring if we can bill the insurance company to get reimbursed for the out of pocket cost. Hopefully this will clarify my initial question and thank you so much for your response.
As stated above, you cannot bill the facility fee if you are not the facility. I too question the "at their own expense". What type of facility is this that they are not billing the facility fee themselves?
That being said, let me explain a situation we previously dealt with. Our office had a AAAASF surgery suite. However, our 1 physician did not often use the space, which made maintaining the certification/employees quite costly. Other ob/gyns in the area would rent the space & employees from us (at attorney verified fair market value) to help offset our expenses. This then made our AAAASF surgery suite an office location for them. They notified the insurances as an additional office location, and billed POS 11 for procedures to receive the appropriate reimbursement. If that is your situation, that the facility is not actually a facility, then you must credential the location and bill POS 11.
If the facility is a true facility, they should not be charging the physician, and billing their facility fee.
That being said, let me explain a situation we previously dealt with. Our office had a AAAASF surgery suite. However, our 1 physician did not often use the space, which made maintaining the certification/employees quite costly. Other ob/gyns in the area would rent the space & employees from us (at attorney verified fair market value) to help offset our expenses. This then made our AAAASF surgery suite an office location for them. They notified the insurances as an additional office location, and billed POS 11 for procedures to receive the appropriate reimbursement. If that is your situation, that the facility is not actually a facility, then you must credential the location and bill POS 11.
If the facility is a true facility, they should not be charging the physician, and billing their facility fee.
thomas7331
Guest
Yes, if your provider is renting the space and assuming all of the costs of practicing within that facility, then that is effectively like have an additional office. Even though it is inside a facility, your provider is not actually owning or operating the facility itself, it just happens to be located there, so it would just be considered another practice location. So I agree with Christine in the post above, you'll just need to credential the location and then when you bill the procedures with the office POS, you'll be paid the higher rate which will include reimbursement for those costs.