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Facility billing for outside physicians

  1. #1
    Default Facility billing for outside physicians
    Medical Coding Books
    I am hoping someone will have experience with this topic.

    Up until recently we had a contract with a group of specialists to come to our facility and see patients one day a month. We had been paying them a flat rate and billing insurances for their services.

    We would like to stop doing this and have the specialist do their own professional billing and we would just bill for the facility piece.

    I don't see a problem with this set up. We would no longer pay them, they would be responsible for their own documentation, billing and collection. We would provide support staff and bill the patients insurance accordingly for our services.

    If anyone is currently doing this or has some feedback about it, I would greatly appreciate it.


    Laura, CPC

  2. #2
    Columbia, MO
    I have experience with this set up. It was not any problem at all. You submit the facility piece on the UB04 using the correct revenue codes, the physician will bill on the CMS 1500 using POS 22. The will not bill for injections or infusions, x rays will depend on how you have it structured , as in does each physician read his own and provide the report or doe you have radiologists that read them and provide the report. Do you have any specific questions I can help you with or was that what you needed?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thanks Debra.

    My main concern is the way the office is setup. It is located in a hospital but the space is rented and the staff is employed by the office not the hospital. If I am understanding everything I have found thus far, we would actually have to change the status of the office to hospital based before we could do this. Is that correct?

    Changing the office status is an option we have been looking at and maybe this will be the push I need to get it done.


    Laura, CPC

  4. #4
    Columbia, MO
    If you are going to charge a facility charge for the clinic encounters then yes this must be changed. The space must belong to the hospital and the staff must be employed by the hospital, otherwise each clinic is a free standing physician office, which they will bill as POS 11.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Thank you very much.

    Laura, CPC

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