# 1500 form facility urgent care billing



## mpekar (Mar 20, 2014)

I am trying to determine the proper billing format for a 1500 claim for urgent care charges for a hospital facility.  These are not the professional charges for the physician.  I am having difficulty understanding how the urgent care?s claim distinguishes itself from the professional physician?s bill which I imagine is also being billed and also on a 1500.  Can you tell me what POS to use for the urgent care charges as well as what goes in box 25, 31, 32, and 33? And how this is different from the professional physician?s claim for the same visit?  I have been told that POS 20 should be used on the facility charges and that the physician?s name still goes in 31 and the facility info goes in 32, would this be correct? I may be wrong but I believe all the charges are to be billed under the hospital?s TIN.  I am thinking that perhaps the facility and physician(physician billing group) and the urgent care all need their own separate NPI and perhaps it only the NPI in 33 which will be different.  Please help!


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## HOLLYGIFFIN (Mar 20, 2014)

I am not an urgent care expert but I do know that Urgent Care is POS 20. I work for a hospital so our hospital (technical) charges are billed on the UB40 with revenue codes and our NPI and the physician bills his services on the 1500 with the appropriate modifiers (-26, etc) to indicate professional services with his/her group NPI. The patient will receive two separate bills as they are two completely different tax entities. So I don't know if your center is a free standing facility owned by the docs or a hospital-based facility that contracts a physician's group like mine.

Below is a link to our local MAC which tells you specifically what is needed in those blanks on the forms. 

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c26.pdf

I also noticed there is an urgent care coding webinar through AAPC. I would also check with our local MAC to see if they have a free webinar on that subject. 

Good luck.
Holly Giffin, CPC


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