Author Topic: Non facility versus facility pricing  (Read 2146 times)

CALI

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Non facility versus facility pricing
« on: February 17, 2012, 10:25:38 AM »
Hi there,
 I billed Medicare for a procedure performed at a surgery center by a doctor who is not employed by the center; I billed Medicare a non facility charge, however they allowed the facility price; I did use the POS 24 because of where the procedure was performed;  is this a new regulation? Medicare told me I could appeal but I don't want to appeal every claim; is there a modifier I can use?
Help!

Michele

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Re: Non facility versus facility pricing
« Reply #1 on: February 20, 2012, 06:45:16 AM »
They are allowing the amount that they allow for a procedure performed in an ambulatory surgery center.  They allow less since the provider who performed the procedure did not have the overhead costs of an office, staff, etc.  So even if the dr is not employed by the center, if he/she comes to the center for perform a procedure he/she didn't have the cost of the facility.  I don't believe that a modifier, or an appeal is going to change anything.

Did I totally miss this question??
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CALI

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Re: Non facility versus facility pricing
« Reply #2 on: February 27, 2012, 11:20:23 AM »
No Michele, you didn't miss the question; thanks so much for your response!