Author Topic: Physicial employed by hospital  (Read 3864 times)

Mary Ann

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Physicial employed by hospital
« on: October 03, 2008, 02:51:32 PM »
When billing for a physician for in and out-patient services, and the physician is employed by the hospital, are those charges billed on the 1500?   Anyone have a website, etc. with info on this type of billing situation?

Michele

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Re: Physicial employed by hospital
« Reply #1 on: October 04, 2008, 07:24:09 PM »
Hi,
   When you are billing for the professional services of a provider you use the CMS 1500 form.  Basically that means if you are billing for the provider's services, not the facility's services.  What info exactly are you looking for?  Info on how to complete a CMS form?

Michele
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jboise

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Re: Physicial employed by hospital
« Reply #2 on: January 22, 2009, 06:20:46 PM »
Adding on to the initial question;

If the hospital, who owes the practice, wants to start billing for a "clinic fee" in addition to the professional services are two claims submitted (one ub-04 and one 1500)?

Michele

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Re: Physicial employed by hospital
« Reply #3 on: January 22, 2009, 08:19:20 PM »
The charges for the facility itself are billed on the UB04 form.  The professional charges for the physician are billed on the CMS 1500 form.

Michele
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Pay_My_Claims

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Re: Physicial employed by hospital
« Reply #4 on: January 22, 2009, 09:40:51 PM »
When billing for a physician for in and out-patient services, and the physician is employed by the hospital, are those charges billed on the 1500?   Anyone have a website, etc. with info on this type of billing situation?

Mary,
Not sure if this is what you are speaking of, but my physician (pediatrician) had admitting privileges at the hospital. When she delivered there, the physician charges were separate and we billed on the HCFA 1500. Even going to some facilities, you will incur facility charges, physician charges, and laboratory charges, and they will be submitted on the appropriate forms.** I hope I didn't confuse you. **

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Re: Physicial employed by hospital
« Reply #4 on: January 22, 2009, 09:40:51 PM »

jboise

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Re: Physicial employed by hospital
« Reply #5 on: January 23, 2009, 11:44:45 AM »
Sorry for the long reply, but this is the ultimate question at hand:

We have a group of hospital owned practices (all set up under the hospitals tax id) who practice in space owned by the hospital.  Currently we are billing out claims with a POS 11.  The hospital is now inclined to start billing these office visits as outpatient services using POS 22.  In addition they would like us to also start billing for a “clinic fee” using a UB-04.  I understand the reasons why and different reimbursement involved, however, I still have questions surrounding the mechanics of the process.

 

1)      When billing for the Clinic fee, is this simply the revenue code level determined by the supplies, nurse time and such items or are other services such as pathology billed as well (my thought is the hospital would submit a separate UB for those services)?

2)      Does the 3 day admit rule apply? If so, and an admission takes place, does the hospital bill for the clinic fee?

 

Does anyone in this forum have this sort of billing arrangement, and would be willing to talk with me?

Thank you,

Jarod


Michele

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Re: Physicial employed by hospital
« Reply #6 on: January 24, 2009, 10:59:52 AM »
I haven't billed this specific setting before.  But I can answer question number 1.  Yes, the clinic fee would be the rev code billed on the UB04 form, separate from the physician's charges for the visit.

2.  I don't know how this works on the 3 day admit rule.

Somebody else???

Michele
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Re: Physicial employed by hospital
« Reply #6 on: January 24, 2009, 10:59:52 AM »