Wiki Provider Based Clinics

[wonder1963]

I am needing assistance with correct format for billing Medicare claims for a provider based clinic under a CAH , specifically what name/Npi do we list in the billing provider loop and service facility loop on a UB?

Thanks
Tiffany

 

[thomas7331]

The UB claims will always be billed under the hospital's NPI.

 

[wonder1963]

Thomas, Thank you but what about the location the services were rendered? The Service facility loop 2310E ? Should the clinics name and address be listed in this loop? Should it also include the clinics NPI if it has been assigned one?

Tiffany

 

[thomas7331]

Per this CMS reference, that loop is not used and is to be left blank:

https://www.cms.gov/medicare/billing/electronicbillingeditrans/downloads/5010a2837acg.pdf

For non-Medicare payers I think you'd need to contact their EDI departments to say for sure, but in my experience, provider-based services are just billed under the hospital's credentials - there's no need to add information specific to the sub-location within the hospital system.

 

[lorettah]

I am needing assistance with correct format for billing Medicare claims for a provider based clinic under a CAH , specifically what name/Npi do we list in the billing provider loop and service facility loop on a UB?

Thanks
Tiffany

It has been at a year since I have done provider based billing and it was for an Acute Care Hospital so the rules might be different. Everything was billed under the facility NPI, but the service location also had to be included if they were not on the same campus as the facility.

MLN Matters Number: SE18002
Claim level information: Medicare outpatient service providers report the service facility location for off-campus, outpatient, provider-based department of a hospital facilities in the 2310E loop of the 837 institutional claim transaction. Direct Data Entry (DDE) submitters also are required to report the service facility location for off-campus, outpatient, provider-based department of a hospital facilities. Paper submitters report the service facility address information in Form Locator (FL) “01” on the paper claim form. For MPFS services, Medicare systems use this service facility information to determine the applicable payment method or locality whenever it is present.

 

[wonder1963]

what about MLN SE18002 ?