New provider-based billing reimbursement policy goes into effect June 1
In alignment with industry standards, we’re updating our provider-based billing reimbursement practices.
What’s changing?
Effective June 1, we’ll no longer separately reimburse for clinic fees or any other fees associated with space used to provide E/M services, when billed on a UB-04 facility claim, regardless of the office being located on the hospital campus and/or using the hospital TIN.
This update will apply to all commercial lines of business for in- and out-of-network providers and facilities (excluding RHC and FQHC), regardless of reimbursement methodology.
What do you need to know?
We’ve published a new provider-based billing policy to support you in understanding:
- What’s included in both non-facility and facility reimbursement rates
- How these rates apply to a claim based on the place of service (POS) code
- The conditions under which a claim will be denied
You should continue to bill the most appropriate place of service (POS) code for services rendered in your practice setting.