Wiki Hospital billing for Surgeon

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laura_clffrd@yahoo.com

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So currently we are billing a surgeon fee for mostly biopsies, colon resections, and hernias. Problem is the hospital is trying to get them on board and they don't want to. They like our services and have been with us a few years. Now the Hospital is saying if they don't sign up with them, then the surgeon will have to do the facility billing as well. Any ideas how this would work or links for help?
Thanks!:D
 
Am I correct in assuming you are a billing service for the surgeon that performs services at the hospital? I do not know how on earth they expect the surgeon to bill for the facility fee? The only time the surgeon could bill the facility fee is if they own the facility, to my knoweldge. I think this could be a scare tactic??? I current bill OB-GYN services that our physicians perform at the hospital and I would not think I could bill the facility charges because I would not know what info to bill under, for example NPI etc. Those are easy to find out, but I have NEVER heard of the surgeon billing for the facility!
 
Yeah me neither... I have only done professional billing, so we were looking into if our software would support the ub forms and icd codes. I am curious if they would have to "rent it" or if that is even heard of? My supervisor has asked me to research and see what I can find out because their contract is due soon. The hospital has told them they will no longer be doing the facility billing for them and if the surgeons do not sign up with the hospital. If they choose to keep their current billing party then they will need to do the facility side themselves.
 
I am a billing company and also bill for a general surgeon. What was stated above is accurate. Only the person/entity/group that "owns" the facility where services are performed can bill "facility fees." Therefore, the hospital is billing the facility fees now. OR, possibly the hospital billing person is completely clueless and they are not billing anything. I would assume if that were the case the "unbilled facility fees" would be identified pretty quickly.

It sounds to me like there is a gross misunderstanding and/or someone does not have all the facts. Most likely the hospital is already billing the facility fee and the doctor is not missing out on anything since he/she would not be due anything for surgeries other than his/her professional fee for the procedures being performed.

Hunter Smith, CPC
 
I am still baffled as to why the hospital would say such a thing. If the facility fees were not billed it would not hurt the surgeon at all because he is not being reimbursed any money for the facility fee now!!! The hospital will lose out because they would be housing surgeries and using supplies for no reimbursement. ????????? What you are being told makes no sense!
 
I think there are 2 possible explanations:
1) There is a gross misunderstanding and one person (or more) have completely no clue what has actually been said.

or

2) The hospital is somehow trying to gain business and their strategy is to gamble on the fact they can tell the Dr. anything and the Dr. will believe them as he/she has (like most Dr's) not even a basic undestanding about the business side of medicine.

Hunter Smith, CPC
 
I believe it is a scare tatic... we are currently billing the surgeons portion... the hospital has told him that he needs to bill the facility charge or sign up with them and they will bill everything together. ... not needing us anymore... Thanks for all the responses, I will bring this back to the office.
 
I have some experience in this. This is what the hospital means: The doctor will have to rent the O/R from the hospital for a contracted price. Then the physician will bill the charges with a place of service 11 rather than a place of service 22. The O/R becomes part of the physicians office (temporarily) because he/she is paying for it. It is an expense of the doctor. He/she recoups the money because of the higher reimbursement for POS 11 compared to 22.
 
I have some experience with this also. The "big city" hospital tried to get my Ortho docs to rent the O/R from the hospital. My doctors solution...they stopped operating at this particular hospital and starting operating at the two smaller hospitals in the area. Hope your docs don't give in to the hospital pressure!
 
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