Wiki Provider Based Billing

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lenaraamackerjackson@yahoo.com

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Zachary, LA
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Good Afternoon, The clinic that I am currently working at is a provider based clinic and the Clia waived test are getting denied by Medicare because of the place of service (19). Should Clia waived to test place of service be 11 instead of 19 Please advise.
 
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If you're billing from a provider based location, your lab tests should be submitted on the UB-04 facility claim, not on the 1500 claim. The 1500 claim can only contain professional services - all technical charges are paid as part of the hospital outpatient claim. The only labs you'd see on the 1500 would be interpretations that would have a modifier 26.
 
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lenaraamackerjackson@yahoo.com said:
Good Morning,
Should injections, X-ray's, and EKG's be billed on both CMS 1500 forms and UB forms for provider based billing?
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I responded to this question on the other thread that you posted. Hope that helps make it clear.

Does your facility not give you guidance on how provider based billing is supposed to work? Provider based rules are complex and have a lot of requirements in the background, beyond just how to bill. Your hospital's compliance department should be actively involved in setting up policies and procedures for how this is to be done. This isn't something that should just be left up to individual coders and billers to figure out.
 
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