Billing > Billing

Physicial employed by hospital

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jboise:
Sorry for the long reply, but this is the ultimate question at hand:

We have a group of hospital owned practices (all set up under the hospitals tax id) who practice in space owned by the hospital.  Currently we are billing out claims with a POS 11.  The hospital is now inclined to start billing these office visits as outpatient services using POS 22.  In addition they would like us to also start billing for a “clinic fee” using a UB-04.  I understand the reasons why and different reimbursement involved, however, I still have questions surrounding the mechanics of the process.

 

1)      When billing for the Clinic fee, is this simply the revenue code level determined by the supplies, nurse time and such items or are other services such as pathology billed as well (my thought is the hospital would submit a separate UB for those services)?

2)      Does the 3 day admit rule apply? If so, and an admission takes place, does the hospital bill for the clinic fee?

 

Does anyone in this forum have this sort of billing arrangement, and would be willing to talk with me?

Thank you,

Jarod

Michele:
I haven't billed this specific setting before.  But I can answer question number 1.  Yes, the clinic fee would be the rev code billed on the UB04 form, separate from the physician's charges for the visit.

2.  I don't know how this works on the 3 day admit rule.

Somebody else???

Michele

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