Lequita Wilterding asked:
Hello; My HIM manager and I are trying to figure out exactly which way to handle this situation. We are a critical access hospital with Method II and have a scheduled treatment room visit for a simple procedure. A physician actually came to the treatment room and performed the procedure. Do we charge a fee for the facility side to cover the nursing; room and supplies part as well as the physician fee? I am asking this because our procedures are normally done by the nurse and we charge for the procedure code; if it has one; and a "room" charge and roll the two charge amounts together to get our overall charge for the procedure. (Our CDM does not include a room charge allowance in the pricing of the procedure; we add separately depending on where the procedure was performed and then roll together.) I am taking the COC course and thought it would be good to ask others on this forum. Thank you in advance for any help you can give. Remember; we are a CAH with Method II. Thanks;
Lequita
Answer:
Joanne mentioned below: If I am reading the question correctly; the physician would bill separately for himself unless he reassigned benefits to the CAH. I found the information on CMS.gov MLN Matters. MM8387
Hello; My HIM manager and I are trying to figure out exactly which way to handle this situation. We are a critical access hospital with Method II and have a scheduled treatment room visit for a simple procedure. A physician actually came to the treatment room and performed the procedure. Do we charge a fee for the facility side to cover the nursing; room and supplies part as well as the physician fee? I am asking this because our procedures are normally done by the nurse and we charge for the procedure code; if it has one; and a "room" charge and roll the two charge amounts together to get our overall charge for the procedure. (Our CDM does not include a room charge allowance in the pricing of the procedure; we add separately depending on where the procedure was performed and then roll together.) I am taking the COC course and thought it would be good to ask others on this forum. Thank you in advance for any help you can give. Remember; we are a CAH with Method II. Thanks;
Lequita
Answer:
Joanne mentioned below: If I am reading the question correctly; the physician would bill separately for himself unless he reassigned benefits to the CAH. I found the information on CMS.gov MLN Matters. MM8387
Last edited: