Facility fee

[mitchellde]

Can you be more specific? A facility fee can be charged for every facility access so yes there can be multiple facility fees per day per patient, but not way to know for your question as there is not enough information.

 

[mitchellde]

Yes the hospital can charge an outpatient fee. The physician office bills with a POS of 22. The facility will bill a facility fee using E&M codes the level is based on facility specific criteria. Meaning it is different for every facility what criteria is a level 1 or 2 ect. I am not sure but does this address your question?

 

[mitchellde]

yes, that is what I was wondering, but I would also like to find out how the level is determined

The facility must have some type of a "tool" if you will that specifys their own unique system for arriving at the facility level. We ultimately decided on a point system. such as vital signs were 5 points and so forth then when we added it all up if we had less than 10 points we did not charge a level as it took a minimum of 10 points to equal a level 1.
In the facility it is not physician work that determines the level it is utilization of facility resources documented. So you will need to ask the facility for a copy of their E&M tool which is required to be in the policy and procedures manual.

 

[mitchellde]

yes! If it meets the criteria for billing. In your earlier post you asked if a facility fee can be billed in addition to the physician E&M for the same encounter. The answer is yes, this is APCs the facility visit level is assigned to an APC grouping which will determine the amount of reimbursement to the facility. It is how the facility gets the overhead paid for, for the use of the staff and utilities. So if your provider sees the patient in the facility setting your provider may charge an E&M and so does the facility. The provider may charge say a 99213, the facility can charge then say a 99212, if a procedure is aslo performed then just like the provider needs a 25 modifier so does the facility. If a procedure is ordered but performed by facility staff such as an injection or IV administration or even a venipuncture then the provider will not charge for these as it is only facility resources being used for these so the facility will have maybe an E&M with the 25 modifier and a procedure, the provider will have only an E&M code.
Are you coding for both? If you can give a specific scenario I might could be more helpful.

 

[BUTCHER129]

The facility must have some type of a "tool" if you will that specifys their own unique system for arriving at the facility level. We ultimately decided on a point system. such as vital signs were 5 points and so forth then when we added it all up if we had less than 10 points we did not charge a level as it took a minimum of 10 points to equal a level 1.
In the facility it is not physician work that determines the level it is utilization of facility resources documented. So you will need to ask the facility for a copy of their E&M tool which is required to be in the policy and procedures manual.

yes! If it meets the criteria for billing. In your earlier post you asked if a facility fee can be billed in addition to the physician E&M for the same encounter. The answer is yes, this is APCs the facility visit level is assigned to an APC grouping which will determine the amount of reimbursement to the facility. It is how the facility gets the overhead paid for, for the use of the staff and utilities. So if your provider sees the patient in the facility setting your provider may charge an E&M and so does the facility. The provider may charge say a 99213, the facility can charge then say a 99212, if a procedure is aslo performed then just like the provider needs a 25 modifier so does the facility. If a procedure is ordered but performed by facility staff such as an injection or IV administration or even a venipuncture then the provider will not charge for these as it is only facility resources being used for these so the facility will have maybe an E&M with the 25 modifier and a procedure, the provider will have only an E&M code.
Are you coding for both? If you can give a specific scenario I might could be more helpful.

Does The tool used to determine the level for the facility fee need to be completed by a RN, LPN or can it be done by a CMA?

 

[mitchellde]

it can be completed by anyone that is competent to follow the tool and read the documentation, in our facility the coders did this. it is not part o=f the medical record documentation, it is only a tool