Author Topic: Anesthesiologist coming to OB/GYN office per procedure  (Read 1135 times)

Texasbiller

  • Newbie
  • *
  • Posts: 1
Anesthesiologist coming to OB/GYN office per procedure
« on: November 19, 2009, 01:37:54 PM »
We have two Anesthesiologist groups who want to come to our OB/GYN office to provide anesthesia during a procedure.

The first group will not charge the patient anything and bill the insurance only; because they will bill the insurance with POS 11 and recover the facility fee from the insurance.

The second group who wants our business as well, says that it is illegal for the other group to claim they are a facility when they are not and will charge the patient for the facility fee they cannot collect.

Upon further research (not much on this to be found), once source said that while the first group may be paid by the insurance companies, they may be liable for mail fraud or wire fraud statutes to allege a general "scheme to defraud" and allege that the MD (Anesthesiologist) billed as if he were a facility when the industry standard is that the facility must be licensed as such.

I am wondering if there are any insurance guidelines (Medicare or otherwise) which state policy for this type of situation, or if anyone's opinion or experience here what the truth or defacto-standard is when this situation arises.

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: Anesthesiologist coming to OB/GYN office per procedure
« Reply #1 on: November 19, 2009, 04:59:37 PM »
I have one question and one piece of advice.

question:  Why are you speaking to one group about another?

My advice. Refer the situation to the provider's attorney, this is a legal matter
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com