# Provider Based Billing



## coding4fun (May 20, 2010)

Hi Everyone!
Can someone shed some light on provider-based billing.  Who can do provider based billing and who cannot.  I have been reading where some practices who are attached to the Hosp can & are doing provider based billing and need more info.  
Thanks,


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## LindaEV (May 20, 2010)

We have several clinics that are "connected" to a hospital, and we bill as provider-based. What exactly are you needing/asking?


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## coding4fun (May 20, 2010)

My main question would be does the practice have to be connected to the local hosp?  I work for an office which at the current time is not connected to the hosp billing, the physicians still own this practice.  Does this billing only apply to practices which are billed from the hosp?  Our docs, here, have hosp priviledges but do their own billing, etc.  Please email me at frimabilling@embarqmail.com and we can chat further if that is OK with you.


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## firedoc19 (Dec 29, 2010)

*Provider Based Billing Education*

I am looking for some seminar/webinar/bootcamp anything that can provide some education on Provider Based Billing.  We currently have 14 hospital owned physicians, went PBB as of Aug 1 and have approx 14 more docs in que to come on board and things just aren't going to well.  Need help in many areas and are looking for resources to get some, no many questions answered,

Thank you


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## firedoc19 (Apr 15, 2011)

HELP!  I simply cannot wrap my head around the facility E/M side of PPB.  I have right now two different articles written by two different "industry leaders" that say completely the opposite thing!  I would really be interested in linking up with someone who could spare a few minutes to help me with a couple questions and examples.  PLEASE e-mail me at gale.robinson@knoxcommhosp.org

Thanks


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## RVHC (Jun 1, 2011)

We just recently brought on a group of new physicians to bill for, and they are employed by the hospital.  We need to do PBB for them.  Can anyone offer a guideline on how to go about billing for these physicians using the Provider Based Billing Method, or offer websites.  Thanks!


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## gdicrocco (Jun 9, 2011)

Check out this website.  I was given this link a couple of years ago by a consultant.  It has a lot of historical information about Provider Based status/billing, but it is also maintained regularly so the info is also up to date.  Lots of resources.  The CMS FAQ link might be a good place to start.

http://www.apcnow.com/pbrinformationtoolkit.htm


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## celtichrt2001 (Jun 9, 2011)

*Ppb*

We bill for a lot of hospital-based physicians who are employed by the hospital. We bill with the same TIN but use the professional cpt codes. Our place of service is either inpatient or outpatient/observation. If they do any kind of ultrasounds, etc, we use the 26 modifier since they are using the hospital's equipment. Does this help?

We also have provider's that we employ but are hospital-based. We bill the same way.


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## violet harrison (Jun 9, 2011)

*Ppb*

I am having some of the same concerns regarding hospital owned practices and provider based billing.  What is the correct way that will meet compliance regulations with Medicare?  Do we bill using the spliting billing method or mirror the physician's charges or do we use a criteria sheet and charge levels on the hospital side?


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## kwhite2008 (Jul 7, 2015)

*Service Facility*

Do you bill the hospital facility name, address and NPI as the servicing on the UB and the clinic facility name, address and NPI as the servicing on the HCFA?

Thanks, 

Kim


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## thomas7331 (Jul 7, 2015)

This is a pretty complex issue and one that your facility's legal or compliance department should be involved in.  The first step is meeting the requirements to be able to call a location 'provider based' which involves a lot of things involving ownership, operation, supervision, shared medical records, attestations and notifying patients, (see:  http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/A03030.pdf).

Once you know that a location is provider based, then you will 'split bill' and all of your facility charges, includes use of the clinic, drugs, supplies, staff services, technical components, etc., will be billed on the UB claim.  Physician and NPP services will be billed under the individual providers' credentials on the 1500 with an 22 place of service and no 'incident to' services can be billed on the professional claim (see Medicare Benefit Policy Manual, Chapter 6, section 20.5.1).

Thomas Field, CPC, CEMC


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## thomas7331 (Jul 7, 2015)

...and to make it all the more complicated, you'll find that some commercial payers won't recognize your provider based status and you may have to customize your billing accordingly!


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## amonroe (Jun 19, 2018)

*Provider Based Practice Billing*

Question:  My question specifically is as an independent pathology lab if a "provider based practice" sends the independent lab a specimen for pathology, the lab performs both the global and professional components can the laboratory globally bill insurance?  Or, because the referring practice is owned by the hospital is the lab “by law” required to bill the our TC (technical component) charge back to the hospital?

Thank you,

Angela

ANGELA MONROE, CPC, CPCO
Billing Manager
Pathologists Diagnostic Laboratory, PA
1901 S. Hawthorne Rd., Suite 360
Winston Salem. NC  27103
Email:    amonroe@pdlpath.com


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## suebindy (Feb 25, 2019)

Hi All -

Under the Psychiatric Collaborative Care Model (CoCM) model, are the CSW’s services considered “incident to” the billing physician’s services?  If so, can CoCM not be billed in a provider-based setting (POS 22) where incident-to billing is not recognized?


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