Wiki E/M Outpatient

[edavis7]

Hello, I would like to know if a provider sees a PT in an outpatient clinic (the clinic is attached to the hospital) and wants to be paid for his professional service. How would it be billed?

The outpatient clinic is billing for the facility services and the provider is also the rendering provider on the facilities claim.

I did bill a claim with 99214 POS 22 and the claim was denied for services already processed and paid.

Thank you for your help.

 

[Naveen Rachagolla]

The Clinic has already billed the claim for their services with pos 22 and under that Hospital Tax ID.

You need to bill the claim with POS 11 and with the Tax ID of the Hospital because that clinic is attached to the hospital.

 

[mitchellde]

No you cannot use POS 11 for services rendered in a hospital outpatient clinic, it is POS 22. It is possible that the facility also billed for the providers portion of the visit in addition to the facility portion. Many facilities do this if the providers are salaried or contracted. Check with the facility billing first.

 

[Naveen Rachagolla]

No you cannot use POS 11 for services rendered in a hospital outpatient clinic, it is POS 22. It is possible that the facility also billed for the providers portion of the visit in addition to the facility portion. Many facilities do this if the providers are salaried or contracted. Check with the facility billing first.

Then how will the physician will be paid for his services ?

My thinking is that, since it is clinic and sharing the Tax ID of the hospital and more over the clinic already has billed with POS 22 and if the physician again bills with POS 22 it will be deniad with Duplicate claim.t wondering

Just wondering how will the physician get paid ?

 

[mitchellde]

Then how will the physician will be paid for his services ?

My thinking is that, since it is clinic and sharing the Tax ID of the hospital and more over the clinic already has billed with POS 22 and if the physician again bills with POS 22 it will be deniad with Duplicate claim.t wondering

Just wondering how will the physician get paid ?

Facility does not bill on the same claim type as the physician and they do not use POS codes, they use Bill type and revenue codes. It is commonly done and all other physicians get paid for their clinic visits. There is something else wrong here. The facility uses the same set of E&M codes as the physician but they have a different meaning so it is entirely possible for the facility to submit a 99214 for the revenue center 510, and the physician to submit a 99214 for POS 22 and both will be paid. It is extremely important that you not bill the wrong POS as the amount of reimbursement is different depending.
However some facilities will bill the physician charge on the facility claim with a physician revenue code, this too is common if the physician is salaried by the facility.