Author Topic: Help  (Read 1858 times)

Robyn

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Help
« on: December 01, 2008, 08:08:06 PM »
I have a medical billing company and just signed on a Plastic Surgeon. He wants me to bill for him and his ASC. I have never billed for facilities before, only the professional services. The question I have is, do I bill his professional surgical codes on a HCFA-1500 and the facility codes on the UB04? How do I know what codes to use for the facility? Is there a coding book like the CPT book for them or are they all the same codes? When would I bill with the 26 modifier? If a patient is having breast reconstruction and needs an implant, who do I bill the implant to? Would that get billed to the insurance?

I know I have soooo many questions, but anything you can do to help would be greatly appreciated!!!

Michele

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Re: Help
« Reply #1 on: December 02, 2008, 06:40:24 AM »
Sounds like it was a good pick up for you!  The facility portion will be good. 

Yes, the Drs professional fees go out on the CMS form and the facility fees go out on the UB04.  On the UB04 you will need to use Rev codes instead of cpt codes, and there are a few other differences.  There is a book called the UB92 editor, but it is about $400 and very difficult to wade thru.  It is intended for hospitals.  We found ourselves in a similar situation several years ago and I had to purchase the UB92 editor to figure out how to bill on the UB04 (UB92 at the time).  About a year ago, we put together a manual on how to complete a UB04 form, completely and correctly, line by line, box by box.  Our manual includes a list of rev codes, and other codes that you will need to know.  For more information on that book visit:  http://www.medicalbillinglive.com/UB04-forms-book.shtml

It seems overwhelming at first, but it really isn't too bad.  You will be able to figure it out!

Best of luck!
Michele
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4PLASTICS

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Re: Help
« Reply #2 on: December 13, 2008, 11:25:05 AM »
I have experience with billing for a plastic surgeon and would be happy to talk to you --- we actually bill our facility claims on a HCFA1500 because unless it is indicated in the insurance contract you do not have to bill on a UB04 -- You can use the SG modifier on the same CPT codes that you used for the physician claim. 

Please feel free to contact me at 770-834-6302

--Tracey Dodson

Michele

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Re: Help
« Reply #3 on: December 14, 2008, 03:04:06 PM »
Thanks Tracey, that's a nice offer.  :)

Michele
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people63

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Re: Help
« Reply #4 on: August 13, 2009, 09:50:03 PM »
Dear Tracy,

I am starting to work at a Plastic Surgeons office in medical billing and need to know about billing for his procedures as a facility. What website can I use to study and become familiar with facility billing? We will submit the claims for his patients on reconstructive surgery and I need to learn.Can you help me?

All My Best,
Diane

Nancyo2

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Re: Help
« Reply #5 on: August 17, 2009, 01:50:10 PM »
Hi Robyn,
Several years ago, our surgery office started billing insurance companies for Facility.  I was fortunate enough to find Ask the Biller and they answered many of my questions.  However, when the claim was changed to UB04, ordering Michele's guidebook on how to complete an UB04form was so helpful!  Although some insurance companies accept a CMS1500, a few insist on the UB04.  Nancy O.