Billing > Facility Billing

Facility definition

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dennisnmnb:
We are a sort of a hybrid organization, and have been billing cpt codes using the cms 1500 form for each provider in the program and have a lot of billing issues as this is a "best fit" kind of arrangement.  I know nothing about facility codes, but am thinking we might fit the cms definition as an Independent Clinic.  Can we bill on a UB 40 as a facility using a "49 Independent Clinic" place of service and use the 1500 in addition for various parts of the professional component of our services?  One of the forum questions by a plastic surgeon biller leads me to this question.  Any ideas on the rev codes we might use?

Michele:
It sounds like that may be correct, but you can't just bill on the UB04 form.  If you are participating with the insurance carriers you need to make sure you are credentialed as a facility.  If you aren't credentialed as a facility then the insurance carriers won't process the UB04's. 

Hope that helps you out.

Michele

midwifebiller:
What if your provider is a non-contracted, non-solicited provider? Are there some general guidelines to follow? I bill for clinic-based providers who use supplies on a regular basis. When I bill these on a CMS-1500 form, often these charges are denied and there is a note that these should be billed on a UB-04. Is this appropriate for a clinic?

~Kelli

Michele:
It sounds like it would be appropriate for what you are describing.

Michele

midwifebiller:
Thank you--I'll give it a try.

~Kelli

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