Wiki Pre-Op billing requirements for facility?

[ahodge90]

Good afternoon,

I need to ask for some help with something.
I was recently asked to look into what is allowed to be billed for a facility when it comes to pre op visits. I am aware of can be be done on the pro-fee side on this, but I am curious if the same rules would apply in a facility setting.

Any help on this would be greatly appreciated!

 

[CBLENNIE]

What could be separately billable from the inpatient facility claim is going to vary by each insurance companies, including Medicare. The insurance company I work for typically has a clause in our facility contracts, which indicates any outpatient care within 3 days (or 72 hours) of an inpatient admission, if the pricing for the inpatient claim is based on a DRG, is included in the DRG allowance for the inpatient admission.

So, you are going to need to review each of your contracts and then determine if the inpatient admission facility allowance is based on a DRG allowance or not.