Wiki IOP question

[marmarchowin@gmail.com]

Hi,
One of my providers now wants to do IOP in his private practice. I am not sure that a private practice can do IOP in his office? Does he need to credential his facility as an IOP facility instead of office? And what the place of service would be? 22?

 

[Cavalier40]

You would actually need to credential a facility that is separate from the professional practice and also get licensing from your state agency. (for Florida its DCF) Also keep in mind that many insurances require JACHO or CARF accreditation in order to pay claims.

There would be no POS like on a 1500 form as the facility claim would be billed on a UB04. Even though its not 100% accurate most insurance companies would want a bill type code of 13X for outpatient services.

I would also keep in mind self referral ethics. There are certain rules that apply to ownership and referral practices between a private professional practice and a facility.