Wiki Need some help with this question

[srich64]

Hi,
A friend of mine asked me this.

She's a patient in a local clinic where they are doing the following.

The family practice clinic is owned by a hospital. Recently, they began billing their patients for both a physician (MD) service and a facility usage fee. Patient's are outraged. Everyone is getting 2 bills for things like sore throats, the flu, back pain.


Anyone know the legality of this?


Love to hear your thoughts.

 

[mitchellde]

If the services are provided in an outpatient clinic which is what this sounds like, then physician submits a claim with POS 22 and the facility sumbits a claim with a 510 rev center. The physician may bill for an E&M service and so may the facility. It is very legal, in theory if you combine both bills it should equal that of a physician office POS 11 claim. with a POS 22 the provider does not recoup for overhead expenses such as the physical site and the nursing staff and the drugs and supplies, that is the facilities.

 

[srich64]

If the services are provided in an outpatient clinic which is what this sounds like, then physician submits a claim with POS 22 and the facility sumbits a claim with a 510 rev center. The physician may bill for an E&M service and so may the facility. It is very legal, in theory if you combine both bills it should equal that of a physician office POS 11 claim. with a POS 22 the provider does not recoup for overhead expenses such as the physical site and the nursing staff and the drugs and supplies, that is the facilities.

Thanks Debra,
Glad to hear this is legal. It will probably take the patient's awhile to understand, and knowing this clinic - there was probably no explanation before they began billing this way!