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bill2doc

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Hi there,

Im confused by the difference between hospital outpatient and ASC. Doc performed a ESWL 50590 on a patient that was outpatient at the hospital but face sheet reads Ambulatory Surgery. Not sure if my POS is 22 or 24. How do I know the difference? Is 24only for a stand alone surgery center meaning not connected to the hospital at all ??

I want to be sure my place of service is correct as I believe it has an effect on the payment.

Any help would be appreciated

Thanks!
Lynn
 
If the facility where the services were performed is a Hospital and services were performed as outpatient then POS 22 would be billed - If the facility is licensed/certified as an Ambulatory facility - then POS 24 would be billed
 
How would I find out if they are licensed/certified as an Ambulatory facility? Are they one (hospital) or the other (ASC) ?

I'm worried that I am billing incorrectly using POS 22 when it should be POS 24 and therefore getting a lower reimbursement for Part B fee-for-service professional claims

50590 on the 2013 Fee for Service shows 612.83 while the ASC fee schedule shows 2122.52

You can understand my panic. Am I loosing revnue by using POS 22 instead of POS 24 or is this fee schedule that I see for ASC the facility payment???

2013 Revised ASC Fee Schedule
 
I would call and verify.

The person who keyed in the info, might have selected ambulatory surgery instead of what you're used to seeing. I know our POS is 22 anytime my docs perform outpatient endoscopies scheduled at the hospital. The hospital face sheets our physicians bring back shows END for outpatient endoscopies, but sometimes I see SDS (Same day surgery) entered.
 
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The ASC fee schedule should be the amount the Facility is paid, not the amount the physician is paid. The physician is paid for the services performed at an ASC or an out-patient hospital at a reduced rate (the line headed with # sign) for a facility setting, because the physician does not have the same overhead for services performed outside of his office. An ASC is a stand-alone (not hospital based) facility. To be sure, I would contact the facility and ask if they are an ASC or out-patient hospital, so that you use the correct POS. But the reimbursement will be the same either way.

Karen Hill, CPC, CPMA
 
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