Wiki Question about Physician owned ASC

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AimeeA10

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Hi,
I am doing some research for admin on billing in the ASC setting. We are a pain clinic and we are building a new place and they plan to operate it as an ASC. My question is this: If the physician owns (or is employed by) the ASC and we bill for the facility component on the UB and the physician component on the 1500, will we be reimbursed for both? Or can we even do that?

Also, when billing for the ASC part, do we bill for all supplies used during the procedures as well?

I have read on a few different websites but they leave me with more questions. Any assistance would be great. Thanks!
 
Your question is a tough one. If the ASC is operating independently from the physician office (operating under its own tax id), then each would be billed and payed seperately. The patients for the physician with ownership, also need to be made aware of the physicians ownership in the facility (STARK laws).

The supplies are typical bundled into ASC payment. Some payer contracts will reimburse implants and "high-cost" supplies seperately. Some payer contracts may also want a third party to be involved for implants and "high-cost" supplies.

The current Medicare payment systems bundles everything into one payment for the procedure. Multiple procedures are allowed and some items (Alloderm, prostate seeds) can be paid seperately through Addendum AA, BB, etc. I recommend reading the Medicare Claims Processing Manual: Chapter 14 for better clarification.

As far as billing under one unit? I am not sure about that. There are also many other factors that come into play. I would recommend a coporate attorney or a consultant to get involved to handle all of the legalities and administrative functions.
 
So even though the provider owns the asc does not mean that he bills for his supplies because techniclly its the facilitys, right? Just like 77003.
 
Clarification....

So.....if I understand it correctly, the ASC can bill 62310 under revenue code 490, bill 77003 modifier TC, and then the Physician can also bill 62310 (and get reimbursed) and bill 77003 modifer 26. Is that right???

And if so, then do the meds go on the ASC bill or the Physician's bill?
 
If supplies are used in the ASC then they are bundled into the payment for the ASC. If they are used during the visit in the Physicians office, that is different and if that is the only place they are used and they can be billed separately, then yes bill them out. The only supplies that can be billed separately in ASC is with commercial insurances that you have contracted with and have that listed out that stents, implants such as anchors, screws, etc can be billed separately. Medicare does include everything used as part of the procedure in ASC in the payment.
 
Yes the ASC and physician do bill the same codes and both get reimbursed separately for codes billed. If the medication is purchased by the physician, it needs to be billed by the physician. If the ASC purchases the medication, it is considered bundled into the payment so can't be billed separately.
 
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