Wiki Inpatient Setting- Billing Professional and Technical Component

[asewald]

Hello,
I work for a neurology private practice. Our physician also has privileges at an inpatient facility. We would like to start doing EEG's at the inpatient facility with our own equipment and tech (this facility does not have their own EEG equipment or tech), which means we would be billing both the professional and technical component. Is this allowed?
Thank you!

 

[CBLENNIE]

You might run into issues where the facility's contract with the payer is DRG based and in that case, they are likely to deny your technical component charges as included in the DRG payment. The payer will generally advise the provider that they need to contract with the facility to provide these services and be reimbursed under the agreement with the facility not the payer. I see a lot of Medicare Part C appeals for this type of scenario and the appeals are denied for this reason.

 

[thomas7331]

I agree with @CBLENNIE 's post above, though I would say it a little more emphatically: not that you 'might' run into issues, but that you certainly will, and that they payers and not just 'likely' to deny the technical component, but almost always will.

The costs of technical components of all services rendered in a facility (not just inpatient but outpatient also) are the responsibility of the hospital. In about 20 years of working in hospital reimbursement, I've only encountered one hospital contract with a payer that allowed for an outside company to be reimbursed for a technical component and that was a small regional hospital that did not have their own MRI - the payer wrote an exception into the contract that allowed the MRI company to bill for those services.

In addition, I'd mention that hospitals don't allow outside providers to bring in equipment or employees without prior arrangement because if there was a problem or adverse outcome to the patient, the hospital would be liable. Your provider (and possibly also the technician) needs to have a contract with the hospital in place in order to do this. Your provider needs to arrange this in advance and invoice the hospital for the technical components of the EEGs performed, and the hospital will pay the provider directly.