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Thread: Provider Based Billing

  1. #11


    AAPC: Back to School
    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: http://www.cms.gov/Regulations-and-G...ads/A03030.pdf).

    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

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