Reminder: Provider-based billing policy went into effect June 1

As we shared in April, to better align with industry standards, we updated our provider-based billing reimbursement practices.

What changed?

Effective June 1, we 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 applies 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?

Review our provider-based billing policy for details, including:

• 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.