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Billing Outpatient Oncology Services

  1. Default Billing Outpatient Oncology Services
    Medical Coding Books
    Physicians are not employed by the hospital but are contracted through a separate company to provide oncology services in the hospital owned oncology department. All insurance payments should be made to the hospital.

    What claim form is used? UB04 or CMS1500?
    Do you bill professional and facility charges?
    What place of service is used?
    What codes are billed in this scenario as professional vs institutional?


  2. #2
    Dover Seacoast New Hampshire
    It all depends on how your billing department credentials the providers with the payers and how they want to set up their billing. Make sure your providers are re-credentialled to bill under a different TIN than their normal practice, or you'll get denials.

    The hospital can bill both the professional and technical services on the UB, or they can split bill on the 1500 for the pro-fee and the UB for the technical charge. We do the latter, and you'll definitely have to do that if you're only acting as their billing agent. POS is where the patient is registered at the time, either 21 or 22.

    Here's the short answer, but there is a lot if detail and some real specifics that will have to be handled case by case. The codes are typically the same, but the criteria are different. For example, both the physician and the facility can bill E&M, but the physician E&M is calculated differently than the facility E&M, and they need not match. Procedures are billed on both sides, unless there's a P/T split, in which case they're reported separately, either with the appropriate code based on Prof. or Tech, or with the -26 for the physician, if you bill on the 1500. Some services, such as chemo administration are not billed by the provider unless they personally administer. In our facility, that is not the case. Additionally, the facility bills for the meds/supplies, the physician would not.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

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