Physician billing in an inpatient setting

by Lucas
(Vancouver)

Hello,


I have read some other posts on this website and the answers seem to be very thoughtful and informative, so thank you in advance for any help with this issue.

I am trying to make sense of a set of Medicare claims information. That is, I have a stack of Medicare claims from both physicians (CMS-1500 forms) and hospitals (UB-40 forms). I am trying to understand the claims submission process. When a physician performs a surgical procedure in a hospital on an inpatient, are both forms submitted, the UB-40 form submitted by the hospital recording the procedure with an ICD-9 code, and the 1500 form submitted by the physician recording the procedure with a HCPCS code?

I do not have a good sense of how the facility bills in this scenario and how the operating physician bills.

Thank you for any clarity you can provide.

Best wishes,

Lucas

Response:

Yes - both forms are submitted when a provider performs procedures in a hospital. The provider’s office or billing service will typically submit the claim for their services while the hospital’s billing office (or service) will submit their UB-04 (CMS-1450).

As you probably know hospital coding is quite different than coding for a provider. Although the ICD-9 (diagnosis) codes are the same, you may use a number of different procedure codes depending on the type of facility setting - such as for a hospital.

The UB-04 is more complicated because of the many different services provided by the hospital. In addition to the facilities, they also provide supplies, medication, transportation, meals, nursing, etc. Patients also frequently have many different diagnosis codes when in a hospital associated with illness, injury, and the associated surgical procedures. Because of this a hospital bills for many more HCPCS codes than a provider does.

Hope this answers your question.

Click here to post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Your Questions.

Recent Articles

  1. 2017 Physicians Practice Staff Salary Survey Results - Medical Billing & Coding

    May 21, 17 09:36 PM

    Physician's Practice has released their 2017 staff salary survey results. We take a look at the Medical Billing and Coding salaries.

    Read More

  2. Outsourcing Medical Billing Services to India

    May 18, 17 11:52 AM

    Has anyone had experience with their providers medical billing services to companies based in India - or any other country? One of our clients is considering

    Read More

  3. Challenges of Getting New Clients for Established Medical Billing Service

    May 14, 17 10:53 AM

    We have a small medical billing company. We pride ourselves on personalized service and actively, often for free, consulting with our clients to make their

    Read More

Disclaimer and Privacy

All-Things-Medical-Billing.com provides this website as a service. Please read our full Disclaimer and Privacy Policy here.


Copyright 2017 All-Things-Medical-Billing.com