Page 2 of 2 FirstFirst 12
Results 11 to 12 of 12

Provider Based Billing

  1. #11
    Exam Training Packages
    This is a pretty complex issue and one that your facility's legal or compliance department should be involved in. The first step is meeting the requirements to be able to call a location 'provider based' which involves a lot of things involving ownership, operation, supervision, shared medical records, attestations and notifying patients, (see:

    Once you know that a location is provider based, then you will 'split bill' and all of your facility charges, includes use of the clinic, drugs, supplies, staff services, technical components, etc., will be billed on the UB claim. Physician and NPP services will be billed under the individual providers' credentials on the 1500 with an 22 place of service and no 'incident to' services can be billed on the professional claim (see Medicare Benefit Policy Manual, Chapter 6, section 20.5.1).

    Thomas Field, CPC, CEMC
    Thomas Field, CPC, CEMC

  2. #12
    ...and to make it all the more complicated, you'll find that some commercial payers won't recognize your provider based status and you may have to customize your billing accordingly!
    Thomas Field, CPC, CEMC

Page 2 of 2 FirstFirst 12

Similar Threads

  1. provider based billing
    By daisy123@ in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 01-30-2015, 09:01 AM
  2. Provider Based Billing Please HELP!!!!!
    By TBEATSON in forum Billing/Reimbursement
    Replies: 2
    Last Post: 02-21-2012, 07:58 AM
  3. Provider Based Billing
    By tamyrahitz in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 05-17-2011, 09:52 AM
  4. Provider Based Billing-Help
    By mmunoz21 in forum Medicare Regulations
    Replies: 5
    Last Post: 09-27-2009, 11:06 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.