Wiki Medicare ASC billing

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abs1821

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We have been billing for our ASC since January. We use a CMS 1500 since they do not accept UB04 for part B. We have been putting the Dr. as Rendering provider and putting Dr's NPI in 24J and then listing the Facility as the Billing provider with the facility NPI. These claims are now denying stating the Dr. is not affiliated with the group...however this isn't a group and I was told by our credentialing dept that Dr's don't need to be linked to a facility to bill. Should facility NPI go in 24J and Dr's NPI go in 33?
 
On the UB-04, in box 1,2,we enter the facility name. in box 5 we have our tax id #. In box 51 and 56 we have our facility NPI # Down in box 76, 77 we have the attending and operating providers name and NPI. Hope this helps.
 
We can't bill a UB04 for this facility because it's part B...we were told Part B medicare doesn't accept a UB04 at this time. Part A does.
 
ASC Medicare Billing Form

Do we use claim form 1500 to bill Medicare for ASC services? I am getting conflicting information. When we called our local Medicare Carrier they don't know. Please help if you are doing ASC billing. Thank you
 
Are you using an SG modifier on your procedure code? If not, your payer's system may be interpreting the claim as the professional fee and denying since the provider type of the ASC conflicts with the professional type of service?
 
Medicare quit using the -SG modifier for ASC's in 2008, although some non-Medicare payers still require it for ASC/facility billing. The 2 MACs I have billed for ASC/facility billing (WPS and NGS) have both required we bill on a HCFA.
 
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