# Provider Based Billing- OB/GYN Clinic



## jortego (Nov 8, 2012)

We are an OB/GYN clinic and were recently bought out by the hospital. This is the first time the hospital has employed a physician practice. They are wanting to set up billing as a provider based practice under the hosptial tax id information. Does anyone have any information on how this is done? New to this. Please and thank you.  Jill


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## jortego (Nov 9, 2012)

Anyone??? If you have an references where I can find this information, that would help too.


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## kvangoor (Nov 12, 2012)

I used to work for a hospital owned practice. We had our own tax id, seperate from the hospital. We billed under that, even though we were owned by the hospital. Not sure if you can be under the hospital's tax id since you would not be doing "facility" charges.


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## Pam Brooks (Nov 12, 2012)

Just because your practice has been purchased by the hospital doesn't mean you'll definitely be doing provider based billing.

Check to see if you'll be billing under a separate physician corproation TIN, in which case you'll be billing as if you were a practice.

If your practice is going to be considered a department of the hospital, and billing under the TIN of the hospital, then you will be doing "provider based billing", which means you submit a professional fee charge on a 1500 (same as you do now), and a corresponding technical charge/facility on a UB for government payers. 

You'll have to set up your criteria for the technical charge, which is usually a level visit based on the nursing resources used for the visit. That's what is billed on the UB. For your 1500, you'll bill your usual E&M and your POS will be outpatient hosptial (your "office" is now considered POS 22). Surgeries will be billed out as they usually are, because they're done in the hospital facility, and those technical charges are unrelated to the "office", but office procedures will be done with both a professional and technical fee in the new "outpatient department". 

There are pros and cons. Of course there is the increased revenue for the provider-based billing...but your Medicare population will now get two bills for what used to be an "office visit". Your staff will need to have devised some very good scripts to communicate this to the patients, because your billers will get a bazillion calls at first. Eventually, it irons out, but it's a lot of extra work if your billing systems don't allow you to "split" bill without having to post two sets of charges for each service. 

Does this help?


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## Sueedwards (Nov 27, 2012)

Love the information you gave Pam.... our hospital is doing the same thing, we are buying out a "Woman's Center" with a cut off date of December 28th.... so we are planning on once the girls deliver to have to separate pre/post delivery's and prenatel visits.  

Any more information you have would be greatly appreciated!!!  Since I am a facility girl I want to make sure I have everything covered!! 

Thanks, Sue


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## Huntsmantollers1 (Jan 30, 2013)

Pam,

We have a hospital offering an area to use as "provider based billing" which I understand will be billed by us as pos 22 however they are also wanting us to pay rent for the space.  I thought this was not allowed,  have you ever heard of rent being charged by the hospital offering an area for provider based billing?

Thanks!


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