Author Topic: Facility Hospital Bill  (Read 1025 times)

Tameka79

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Facility Hospital Bill
« on: August 09, 2016, 09:29:25 AM »
Good Morning,

I am looking over a hospital bill for someone and I am not very familiar with facility billing so I was wondering if someone could help me.  The pt. had a Colonoscopy done and my first question was I know facilities do not bill cpt codes, but how does the insurance company know what's being billed? On her itemized statement there are numbers, 6-9, but on the EOB it just says drugs, supplies, operating room, etc..... How does the insurance company know that they are not being over charged?

Also, I noticed on the itemized statement it says "Surgical Path Level 4" 3units, I presume, $502.98, but then the patient received a bill in the amount of $502.98 from the Pathologist as well.  I know that the specimen has to be taken and then read, but I guess why I am questioning it is because it is for the same exact price.

Also, in order to learn facility billing would I have to take a facility coding course? I know for physcian billing you can take a physicain based billing course and if you wanted to learn physician coding you could take a physician based coding course.  But I am not sure when it comes to hospital billing. 

Any clarification would be greatly appreciated. 
« Last Edit: August 09, 2016, 09:34:49 AM by Tameka79 »

Michele

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Re: Facility Hospital Bill
« Reply #1 on: August 10, 2016, 09:03:54 AM »
Good Morning,

I am looking over a hospital bill for someone and I am not very familiar with facility billing so I was wondering if someone could help me.  The pt. had a Colonoscopy done and my first question was I know facilities do not bill cpt codes, but how does the insurance company know what's being billed?

Facilities use Rev codes to indicate what they are charging for.  There is also a field on the UB04 to indicate the CPT code of the surgery that was performed.  So the insurance carriers know exactly what is being billed.  For example, for a colonoscopy the rev code could be something like 0490 with the colonoscopy code in field 74.


On her itemized statement there are numbers, 6-9, but on the EOB it just says drugs, supplies, operating room, etc..... How does the insurance company know that they are not being over charged?

I have no idea what 6-9 means, but the EOB showing "drugs, supplies, operating room, etc is the fee for the facility.  They bundle everything into the one rev code for using the surgical suite.


Also, I noticed on the itemized statement it says "Surgical Path Level 4" 3units, I presume, $502.98, but then the patient received a bill in the amount of $502.98 from the Pathologist as well.  I know that the specimen has to be taken and then read, but I guess why I am questioning it is because it is for the same exact price.

If the patient received a separate bill from a pathologist for the exact same amount I would question that.  If the facility bills for the pathology fee then the pathologist wouldn't bill separately.  There would be a technical component fee from the lab for the pathology.


Also, in order to learn facility billing would I have to take a facility coding course? I know for physcian billing you can take a physicain based billing course and if you wanted to learn physician coding you could take a physician based coding course.  But I am not sure when it comes to hospital billing. 

Any clarification would be greatly appreciated. 

I am not aware of any courses on facility billing.


Hope this helps!


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Tameka79

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Re: Facility Hospital Bill
« Reply #2 on: August 11, 2016, 10:09:51 AM »
Thank you Michelle, it does help a lot.  After reviewing the fees for the Pathologisit it appears to be right because the amount on her itemized bill is for the Pathologist and the other bill she received from the lab is from the lab, not the pathologist.

I am really finding this type of billing intriguing! Thanks again for your help.