Wiki Assistants at Surgery

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Pam Warren

Pam Warren

True Blue
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2,387
Location
Springvale, ME
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1
Our revenue cycle director got wind from another employee that at a previous facility, they billed assistant surgery fees on the 1500 for surgical techs and registered nurses. Have I missed something here? Has anyone ever heard of this, or billed for these staff members? This seems so basically wrong that I'm even second guessing myself!

I was under the assumtion that these kinds of services would be bundled into the hosptial's OR technical charges and billed on the UB, and that the only kind of professional services that could be billed out and reimbursed were for providers who could be credenitalled. There's no ability for any kind of 'incident to' billing in the inpatient setting, so I'm not sure where this is coming from.

I can't wait to hear what you all think about this! :confused:

Pam Brooks, PCS, CPC
Dover, NH
 
curious

So, just curious as to whether they are paying their Tech's as assistants? Wage I'm sure would be much better as an Assistant Surgeon than as a Tech. What do you think? I really don't see how they can pay them as assistants, doesn't it say that they have to perform part of the surgery and explain their part in the OP report?
Just curious.
 
I don't think this is allowed. Internally within the practice they could pay their RN's and surgical tech's more but incident to does not apply to these type of employees.
 
I currently bill for an assistant surgeon, she is CSA and SA-C she assist different doctors and I bill her claims she has an NPI and tax id# and insurance companies pay.

Can anyone answer why you can never bill CMS? Her claims have been billed they will not pay but they do provide a letter to send to secondary insurance companies

She has her own company that she bills under and UHC pays well
 
I beleive that the non-physician practitioners must be removed from the hospital's cost reporting information when it is reported to Medicare and then the facility can bill for and be paid for PA or NPP when appropriate, i.e. assisting an Orthopedic surgeon during surgery. PA's and NPs billing in these situations would be billing direct under the facilities tax id and npi and would have been signed up under the appropriate 855 forms.
 
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