Mobile / portable xray

[Radman85]

Hi everyone, I'm in the process of starting a mobile xray company and I have some questions regarding the billing side of things.  I'm somewhat familiar with the billing aspect regarding SNF/ALF patients.  I'm unfamiliar with the billing aspect for housecall patients and also hospice patients(either in a hospice home or in their own home).  From what I understand there are 4 components which your allowed to bill for with SNF/ALF (professional component, technical component, transportation component, and set-up component).  I've been told that with housecall patients there are  higher fees that are allowed to be charged towards medicare or private insurances.  I'm trying to find out if there is any truth to that, that's my question.  Are you allowed to bill higher fees for these types of patients?  If so, what component is billed differently?  Thanks for any info or advice about this topic.  I can't seem to find the info online and I've tried calling my local MAC in Florida to no avail. 

[kristin]

All I can suggest is this...go to FCSO fee schedule, and look up the codes you will be billing. Take their limiting charge for each code (LC), and times it times 1.3 or 1.5,  round up to the nearest even dollar amount and set that as your fee for that particular code, for every insurance. This SHOULD cover what each will allow, when billed with POS 12 for home, or any other POS that you may go to. You will have write-offs, but that is how it works. You want one fee schedule, that is set to cover whatever insurance will pay the most for that particular code. Watch how various insurances pay, and adjust as needed.

My mother had a mobile x-ray company come to her house in May in Florida for a lung x-ray series, and here is what was billed, and then paid by Medicare, her insurance: X-ray 2 view chest: billed $31.80, paid $24.93. Transport: billed $122.14, paid $95.76. Set-up: billed 26.51, paid $20.79. My mom's cost because she did not have a secondary was $ 36.09. Because the same person took and read the x-rays, there was no need for a professional or technical component, it was just one code for the x-ray, with the transport and set-up as the two other codes. So basically, the entire amount paid to the mobile x-ray company for a two view x-ray of chest between insurance and the patient was: $177.57.

[Radman85]

Thanks for taking the time to explain that Kristin, I'm starting from scratch and this is the most challenging part thus far is trying to get answers to questions.

[kristin]

I wish I could be more help! A few things also I can add is that if you are just taking the x-ray, and someone else is billing for the reading, you would put the TC modifier on the x-ray code(s), and bill at regular price, and insurance will adjust down price accordingly.  The doctor reading x-ray will add the 26 modifier to their codes and also bill whatever their fee schedule is. If you are taking and reading x-ray, then no modifier is required at all.
Depending on POS, that will determine what insurance reimburses, which is why you want your fees to be the same across the board, but never under what your highest payer will pay, regardless of POS.

You mentioned there being higher fees allowed for house call/hospice patients...that is not necessarily true, as fees are sometimes reduced for those POS, because you have no "overhead" factored in, even though you have travel time. Also familiarize yourself with the G modifiers associated with a patient being on hospice with Medicare insurance.  They are GV and GW. This is very important if you want to get paid.

[Michele]

We actually bill for a portable x-ray company.  He does a ton of SNF/ALF.  A few in provider's offices.  As for housecalls, you should be billing the same fee schedule you use for all insurance.  You should have a set fee schedule for all procedures that is billed on all claims.  Then you do a contractual adjustment after the claim is processed.  Insurances will determine the allowed amount based on the CPT code and the place of service. Housecalls are billed with a 12 POS.

I hope that helps!

[Radman85]

Ok good to know this info.  Regarding SNF/ALF patients will I be billing any component to the facility they are at?  Or will I be billing strictly their insurance for the exam?  Also I've heard mixed things about SNF/ALF's and housecalls using mobile imaging companies for their needs.  I've heard they can choose any mobile imaging company at any time for their services, and I've also heard that they have to sign a contract with only one company for an agreed upon length of service.  Can anyone shine some light on this aspect?  Thanks again for the help!

[Michele]

Most SNFs have a contract with one portable xray company.  That contract will state what they will pay.  For example, with the company we bill for, the contracts state that they SNF will pay 80% of Medicare allowed amounts for patients within the part A stay for the TC, the set up and the travel.  The PC is billed to Medicare.