Wiki Hospital Owned Physician Practice Billing

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slaroche

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I work in a hospital owned Physician Billing practice and I have a question about how to bill Medicare when a patient is seen in the Physician office on the same say that they might have had a Hospital service. If a patient was seen at the Lab for a blood draw or any department of the hospital on the same day that the same patient might have been seen by a doctor for an E&M that the hospital charges HAVE to be linked and billed at the same time as the office charges with the same account number. Does anyone know if it is a Medicare requirement that all the facility charges for a patient, meaning the technical charge for the E&M be on one bill?
 
No that is not true, the facility charges are billed on the UB-04 and the physician charges on the 1500. however you can put all charges on the UB-04 and separate the physician charges with the revenue code for physician.
If you are a hospital owned practice then the facility should always generate a facility bill for every patient you see and your POS on your claims is a 22.
I am not sure exactly what you mean by charges linked, but yes there should be facility and professional charges for every encounter.
 
The issue is that the Physician is using an EMR that is separate from the Hospital EMR and billing system. I'm trying to find out if I can bill for the E&M both technical and professional from the Physicain EMR and not include the charges on the UB that the hospital is sending out. Will Medicare pay the two separate claims for the same date of service? I'm being told that all facility charges, which includes the technical charge for the E&M for the patient Have to be on the same claim in order to be paid.
 
the facility will bill out all their charges including the facility E&M on their facility claim. The physician will bill out his/her professional charges on your claim with the POS 22. You cannot bill the facility charges on the professional claim. Yes Mcare will pay the facility claim and the physician claim. The key is the bill type on the UB and the POS on the 1500.
 
So if the facility charges do need to be billed on the UB with all other facility charges do you know if it is critical for all faciltiy charges on a DOS to be on one claim for Meidcare? That is the part I'm struggling with. The problem I'm running into is a timing issue becasue we are using two different EMR's.
Thank you for all help on this one!:)
 
Yes all the facility charges need to be on one claim due to the need for condition codes and modifiers. Hasn't the facility been charging a facility charge for the clinic encounters? Have you been using the POS 22 for all your claims?
 
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