Medical Billing Forum
Billing => Facility Billing => : Anand September 26, 2014, 11:24:00 AM
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I am pretty new to the ASC billing and am in the process of learning things before I start things officially. I understand that ASC are outpt surgical center and do not require hospitalization and of-course you got to be adding SG modifier to say that you are billing of hospital set-up & services.
(i) Is it correct that for ASC there could be two billing - Facility and for professional - and all professional got to be billed under CMS-1500?
that is irrespective of payers, I am also unsure if how does it varies from Commercial vs Medicare/Medicaid -- does the commercial got to be billed in UB and MCR/Medicaid to be under UB04?
or
(ii) When I bill the facility alone I got to use UB 04 across all payers....
I am planning to get the 855I done but we would handle the complete billing so should I get the 855A.. can someone shed some light..
If any link that I can for education purpose do share it as well.
Thanks
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(i) Is it correct that for ASC there could be two billing - Facility and for professional - and all professional got to be billed under CMS-1500?
that is irrespective of payers, I am also unsure if how does it varies from Commercial vs Medicare/Medicaid -- does the commercial got to be billed in UB and MCR/Medicaid to be under UB04?
Yes, the actual facility charges for the ASC (use of the facility) are billed on a UB04 for all payers. The professional charges (surgeon, assistant surgeon, anesthesia, etc) are billed using the CMS 1500. This is the same as if done in a hospital.
or
(ii) When I bill the facility alone I got to use UB 04 across all payers....
I am planning to get the 855I done but we would handle the complete billing so should I get the 855A.. can someone shed some light..
If any link that I can for education purpose do share it as well.
Thanks
If you are enrolling the ASC in Medicare then that is done on the CMS 855A. I think the problem is that you are getting the physicians and the surgery center blurred into one. Even if the surgery center is owned by a physician, the surgery center must be treated separately from the physician. The surgery center must enroll with insurances as a surgery center and the physician must enroll as a physician.
Hope that helps.