Wiki Office Based Surgery Center - Billing a Facility Fee

[jhock]

Hi all!

I have a practice that is AAAHC accredited as an Office Based Surgery Center that would like to bill commercial carriers for facility fees. The OBS has a designated surgical suite and a separate tax ID from the practice. Does anyone have any experience with this? Would the facility fee be billed on a UB04? And if so, what would the facility code & revenue code be?

Thank you for any help!

 

[valerie@omsbillingsolutions.com]

Office Based Surgical center

Hi There,

I am also looking for resources regarding office based surgical center billing as well. The place of service 11 doesn't quite seem fitting however, I am not sure that place of service 24 is accurate either. Any information that that anyone has would be greatly appreciated. thank you.

 

[thomas7331]

This accreditation does not automatically allow for a facility fee to be billed - you will need to review the laws that apply in your location and also enroll or contract with your payers as a facility if they allow you to do so, and bill according to their guidelines as far as which claim form and/or codes should be submitted. If you are not billing a facility fee, then place of service 11 is appropriate so that you are reimbursed a fee that includes the office costs in addition to the professional fees. In cases where you bill a separate facility fee, it's important to use a facility place of service on the professional claim, otherwise your professional claim may be overpaid. Because of the complexity of facility billing and the potential risks associated with inappropriate billing and payment for facility fees in this situation, I'd strongly recommend getting a compliance professional or legal consultant to work with you on this and set up a process to make sure that you are doing this correctly before you proceed - it would be a very worthwhile investment.

Here is a link that provides some good information, even if a little outdated: https://www.beckersasc.com/news-ana...rgery-centers-frequently-asked-questions.html
As stated under 'frequently asked questions':

Q: Once accredited, can I bill facility fees?

A: Office-based accreditation is NOT an avenue to receive facility fees. Local and state law, and third party payer policies (commercial and workers' comp) typically require the facility to be licensed and certified in order for facility fees to be paid. There have been cases of what the prosecution labeled as wire and mail fraud for billing facility fees outside of the ASC program. Insurance companies have also visited office-based surgery practices in an attempt to show a scheme to defraud the insurance company.

Here is another article from this same web site that might be helpful reading: https://www.beckersasc.com/business...andrew-shatz-of-sighttrust-eye-institute.html