Medical Billing Forum

Billing => Facility Billing => Topic started by: Cindy on May 27, 2009, 10:23:21 AM

Title: OH IOP & PHP BILLING
Post by: Cindy on May 27, 2009, 10:23:21 AM
PLEASE, PLEASE HELP

Is there a standard definition of IOP and PHP?  Also on UB04 how do I bill,  a flat rate per day or by the # of hours client attended.  We are an outpatient day treatment facility.  So far not one of the insurance companies including Medicare will answer my question. 
Title: Re: OH IOP & PHP BILLING
Post by: krudolph on May 27, 2009, 10:54:38 AM
I bill IOP for a Drug and Alcohol Facility.  First you need to be set up as Facility Billing on a UB04 with insurance carriers.  If you are a contracted provider for a Facility you should have negotiated a "Per Diem" fee with the carriers.  We bill $275.00 per IOP Session and get reimbursed as low as $130.00 and as high as $175.00 per session from our contracted providers.  Your claims should be set up to be billed with the Facility Information including the Facility NPI and you would bill a "H0015" with the flat fee you charge.  We use a "HO" modifier and revnue code 0906.  Hope this helps.