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Provider Based Billing-Help

  1. #1
    Question Provider Based Billing-Help
    Exam Training Packages
    Medicare allows hospitals to bill for both the physician and hospital outpatient services, in 2 separate charges when a patient is seen in a physician office owned by a hospital..... Is the patient responsible for both co-payments, the provider copay and then the facility copayment? I have been searching in the CMS website and cannot find if that is the case...
    Marilyn CPC, CPC-H, CEMC

  2. #2
    Seacoast- Dover New Hampshire
    We are provider based, CAH. All our Provider's MCR charges go to the hospital and they create the ub with all charges for the day. The pt only pays once. We log info in to the Physcians pt account then transfer it to the hospital side and the providers get their RVU's
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Thanks Karen, that is what I think, the patient should only have to pay the provider co-pay.... do you know or are you aware of anything in the CMS website which clearly defines this Proveder Based Billing and co-pay issues?
    Marilyn CPC, CPC-H, CEMC

  4. #4
    Seacoast- Dover New Hampshire
    Hi Marilyn, We have a CAH Manual..I have never read the whole thing. My managers came up somehow with this billing senario and it has been working for 3 1/2 yrs. I am sorry that I am not of better help. It is called a Critical Access Hospital Manual. The one I have is from 2005. I would hope that there is a more current one. Good luck.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  5. #5
    Columbia, MO
    CAH is a little bit different from acute care in the reimbursement and copay arena, if you are acute care, then look up APC billing and reimbursement. When I worked acute care the patients paid a copay for the physician but not the hospital bill, they had to have met the deductible in most cases but it really depended on the carrier.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    We are provider-based to an acute care hospital. Our Medicare patients are responsible for a copay for both the physician billing (based on physician fee schedule) and facility billing (based on APCs)

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