Vicki Posted Thu 18th of June, 2015 11:46:08 AM
When a surgery being performed in an ASC and general anesthesia is performed, can the ASC bill facility charges for the anesthesia services if the anesthesiologist bills separately for his/her professional charges? If so, how?
SuperCoder Answered Fri 19th of June, 2015 02:28:35 AM
Traditionally, most anesthesia service arrangements involved simple "fee-for-service" relationships where the ASC submits medical bills for the facility fees and the anesthesia service provider submits medical bills for the "professional" services rendered. However, this fee-for-service relationship overlooks and often underestimates the provision of anesthesia services as both a potentially valuable source of revenue for the ASC and, critically, a source of inefficiency for the ASC in terms of compliance standards, quality control and stability.
Market forces necessitated the progression from traditional fee-for-service systems to "employment and/or independent contractor" systems or the more modern "joint-venture" systems.
Anesthesia Service Provider as Employee and/or Independent Contractor: Many ASCs now model their business relationships after the systems found in most hospitals and hire anesthesia service providers as employees and/or independent contractors for the provision of anesthesia services to the ASC's patients. In the employment/independent contractor system, the anesthesia service provider assigns the ASC his or her rights to submit medical bills for the anesthesia services provided to the ASC, and the ASC submits the medical bills to insurance carriers under its own name or under the name of the anesthesia service provider. In exchange, the ASC pays the anesthesia service provider either a flat per-case fee, a salary and/or a predetermined productivity-based fee.
Joint-Venture Systems for Anesthesia Services: ASC's may also consider forming or contracting with a separately formed anesthesia service entity to establish a "joint-venture system" wherein the anesthesia service entity is either owned by the ASC itself, owend by the individual owners of the ASC or, in certain circumstances, owned by select physicians. The joint-venture system allows the anesthesia services entity to submit medical bill for the anesthesia services provided to the ASC, while the ASC continues to bill for the facility fees
Vicki Posted Fri 19th of June, 2015 12:13:46 PM
Thank you for your response however, in the scenario where the anesthesiologist is billing themselves for the professional under their name and TIN, how would the ASC bill for the facility fee for the anesthesia? Using the surgery code with the revenue code indicating anesthesia or using the anesthesia code using the revenue code of anesthesia on a UB04, what about on a HCFCA since some payors require an ASC to bill on a HCFA?
SuperCoder Answered Mon 22nd of June, 2015 02:40:52 AM
The facility should bill for the anesthesia services by billing anesthesia code using the revenue code of anesthesia. The anesthesia would be billed under the revenue code for the facility side and the CPT code that is reported for the professional service would not be appended on the facility claim.
Vicki Posted Mon 22nd of June, 2015 13:29:21 PM
Thank you for the clarification
Vicki Posted Mon 22nd of June, 2015 13:37:55 PM
Again, thank you, however it only answers part of the question, for the UB04 form. How do you submit the facility charges for anesthesia on a HCFA 1500 form since this form does not have a place for revenue codes? SOME payors require the ASC to bill on a HCFA form.
SuperCoder Answered Tue 23rd of June, 2015 01:56:11 AM
When billing for facility services on a CMS-1500 claim form, modifier SG must be billed on the service line(s) in order to identify the claim as a facility charge.
Vicki Posted Tue 23rd of June, 2015 10:37:22 AM
Ah, that is good to know. Again, thank you!
SuperCoder Answered Wed 24th of June, 2015 02:40:13 AM