Medical Billing Forum
Billing => Facility Billing => : Cindy May 27, 2009, 01:23:21 PM
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PLEASE, PLEASE HELP
Is there a standard definition of IOP and PHP? Also on UB04 how do I bill, a flat rate per day or by the # of hours client attended. We are an outpatient day treatment facility. So far not one of the insurance companies including Medicare will answer my question.
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I bill IOP for a Drug and Alcohol Facility. First you need to be set up as Facility Billing on a UB04 with insurance carriers. If you are a contracted provider for a Facility you should have negotiated a "Per Diem" fee with the carriers. We bill $275.00 per IOP Session and get reimbursed as low as $130.00 and as high as $175.00 per session from our contracted providers. Your claims should be set up to be billed with the Facility Information including the Facility NPI and you would bill a "H0015" with the flat fee you charge. We use a "HO" modifier and revnue code 0906. Hope this helps.