Wiki Non facility vs facility

[tangerinebed999]

I have a question, my doctor is interested in doing some procedures at Outpatient Based Lab which he has no partnership in. What is the criteria to bill for higher reimbursement for facility/non-facility. I am getting conflicting information.

 

[thomas7331]

I have a question, my doctor is interested in doing some procedures at Outpatient Based Lab which he has no partnership in. What is the criteria to bill for higher reimbursement for facility/non-facility. I am getting conflicting information.

That sounds like an unusual situation and I'm not sure I'd be able to answer this. Normally non-facility billing is reimbursed higher because the physician is incurring a cost to operate the location (e.g. using their own staff and supplies), but a lab is not considered a facility, so that's not really correct either.

What procedures are going to be performed, and what is the provider's arrangement with the lab as far as who is going to be responsible for the facility costs involved (i.e. paying for the use of the space, the staff on site, the supplies and/or drugs involved in the procedures)? Is this a hospital-owned lab, or independent?

 

[sls314]

I have a question, my doctor is interested in doing some procedures at Outpatient Based Lab which he has no partnership in. What is the criteria to bill for higher reimbursement for facility/non-facility. I am getting conflicting information.

It's not really something that you decide to bill or not.

Reimbursement for facility or non-facility rates is determined by the Place of Service on the claim. You bill the appropriate POS code for where the services were rendered. The payer determines whether to reimburse the facility or non-facility rate based on the reported POS.

Facility reimbursement is lower than non-facility. With facility rates, the provider is being paid for their time/professional services & the facility is submitting a separate claim to get paid for the overhead. With non-facility, the provider is billing for their time/professional services AND the overhead. There isn't a separate facility claim - that's why non-facility reimbursement is higher.