Wiki Provider based billing

tylene1993

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Our facility does provider based billing. We bill both professional and technical fees for all of our office visits. If we have a patient that is scheduled for an office visit and it is decided to do a procedure as well, on the facility side would we also bill for the facility/technical fee as well as the facility fee for the procedure? Or would we just bill for the facility fee for the procedure so the patient is not getting two facility charges. Any help would be appreciated as I am not finding any clear guidelines for this.
 
If your provider owns the equipment you can bill for the technical fee. Now when it comes to the procedure, what POS do you use?
Also, what is the status indicator for that procedure if done in the facility?

What type of facility is this?
 
Hi. I may have mis-interpreted your question, but here is 'my' employer's scenario …. I work for a "facility" that is Provider Based and that has a medical group (what I interpret as Office Visits and who I work under). For e/m with procedures (done 'in the office setting') for a PB insurance (i.e. Medicare) the CPT/HCPCS codes were set up to 'split' between a 1500 and UB claim (something the IT/Finance Depts worked on) when procedures were done in the office (which for PBB (provider based billing) becomes an OP "department" of facility which = POS 19 (off-campus) or POS 22 (on-campus).
An e/m with injection of knee joint w/drug would look something like:
1500 claim === 99213-25 // 20610-RT
UB/Fac Claim ==== G0463-25 // 20610-RT // J7324
Because of PBB - the 'facility' claim bills the drug - 'not' the provider's claim (built into system). The procedure 20610 was 'built' to split onto both claims with the respective RVU calculated amounts (again IT/Finance did that part).
When we became PBB (provider based billing) - This was VERY odd for us (me) who billed for the Med Group (pro-fee) side only. We never knew what a UB claim looked liked or how it 'operated'. Also, because the UB works off of Revenue Codes, whereby the 1500 = CPT/HCPCS, we stumbled hard; BUT LEARNED A LOT. I now know more about Rev Codes than I ever would have. I would start to search i-net re: What is provider based billing. You will get a lot of info. Good luck....
 
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