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Thread: Provider Based Billing

  1. #1
    Join Date
    Apr 2007

    Talking Provider Based Billing

    AAPC: Back to School
    Hi Everyone!
    Can someone shed some light on provider-based billing. Who can do provider based billing and who cannot. I have been reading where some practices who are attached to the Hosp can & are doing provider based billing and need more info.

  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    We have several clinics that are "connected" to a hospital, and we bill as provider-based. What exactly are you needing/asking?
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  3. #3
    Join Date
    Apr 2007


    My main question would be does the practice have to be connected to the local hosp? I work for an office which at the current time is not connected to the hosp billing, the physicians still own this practice. Does this billing only apply to practices which are billed from the hosp? Our docs, here, have hosp priviledges but do their own billing, etc. Please email me at frimabilling@embarqmail.com and we can chat further if that is OK with you.

  4. #4

    Unhappy Provider Based Billing Education

    I am looking for some seminar/webinar/bootcamp anything that can provide some education on Provider Based Billing. We currently have 14 hospital owned physicians, went PBB as of Aug 1 and have approx 14 more docs in que to come on board and things just aren't going to well. Need help in many areas and are looking for resources to get some, no many questions answered,

    Thank you

  5. #5


    HELP! I simply cannot wrap my head around the facility E/M side of PPB. I have right now two different articles written by two different "industry leaders" that say completely the opposite thing! I would really be interested in linking up with someone who could spare a few minutes to help me with a couple questions and examples. PLEASE e-mail me at gale.robinson@knoxcommhosp.org


  6. #6

    Default Provider Based Billing

    We just recently brought on a group of new physicians to bill for, and they are employed by the hospital. We need to do PBB for them. Can anyone offer a guideline on how to go about billing for these physicians using the Provider Based Billing Method, or offer websites. Thanks!

  7. #7

    Default Provider Based Billing

    Check out this website. I was given this link a couple of years ago by a consultant. It has a lot of historical information about Provider Based status/billing, but it is also maintained regularly so the info is also up to date. Lots of resources. The CMS FAQ link might be a good place to start.


  8. #8

    Smile Ppb

    We bill for a lot of hospital-based physicians who are employed by the hospital. We bill with the same TIN but use the professional cpt codes. Our place of service is either inpatient or outpatient/observation. If they do any kind of ultrasounds, etc, we use the 26 modifier since they are using the hospital's equipment. Does this help?

    We also have provider's that we employ but are hospital-based. We bill the same way.
    Last edited by celtichrt2001; 06-09-2011 at 01:51 PM. Reason: Forgot to add something

  9. #9

    Default Ppb

    I am having some of the same concerns regarding hospital owned practices and provider based billing. What is the correct way that will meet compliance regulations with Medicare? Do we bill using the spliting billing method or mirror the physician's charges or do we use a criteria sheet and charge levels on the hospital side?

  10. #10

    Post Service Facility

    Do you bill the hospital facility name, address and NPI as the servicing on the UB and the clinic facility name, address and NPI as the servicing on the HCFA?



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