Wiki Getting a Surgical Facility Paid?

Messages
1
Location
Bradenton, FL
Best answers
0
Good afternoon we have a surgical facility owned by the doctors that they use and we cannot get it paid for by Medicare, Ambetter, Etc, are we doing something wrong in our billing?
 
You may not be doing anything wrong. Various states have various regulations regarding what may be considered a "facility" and licensed as such.
For example, in my state (NY), even if AAAASF certified, you cannot get Article 28 facility accreditation without many, many, many additional requirements and need a team of professionals (lawyer, accountant, etc) to help you through the process.
Without the facility accreditation, the location is considered an office location, and billed with POS 11. You will receive site of service differential, but will not receive a separate payment from the physician bill for the facility.
I did find this for Florida: https://ahca.myflorida.com/health-c...ient-services-unit/ambulatory-surgical-center
Here are some starter questions:
1) How is your facility licensed?
2) Is it a separate location than your office(s)?
3) Do you have a facility contract with the payors?
4) On the physician bill, what is the POS?
5) How are you submitting the facility bill?
6) When was this built? Were you receiving facility payments before?
7) How was this investigated prior to building it out and what were those findings?
Bottom line - depending on your state and their requirements, you may or may not be able to be considered a facility. Good luck!
 
Top