What You Should Know About Provider-based Billing

What You Should Know About Provider-based Billing

Posted by Charla Prillaman
Aug 6, 2019 10:54:07 AM

Since 2012, there has been a dramatic increase of hospital-acquired physician practices. Specifically, that number increased from 35,700 in 2012, to more than 80,000 in 2018, according to a report from Avalere Health and the Physicians Advocacy Institute Research. That’s a whopping 128 percent growth in acquisitions in a little over six years. Unsurprisingly, that trend shows no sign of slowing down today.

But while these acquisitions can provide significant financial resources to the physician practices, and a shot in the arm to a hospital’s bottom line, the sharing of these costs can create confusion on what physicians can (and cannot) bill for. And as we watch healthcare costs continue to rise, and physician reimbursements fall, it’s imperative that physician practices adapt to these potential billing changes.

Under the provider-based billing model (also known as hospital outpatient billing) patients can be charged twice on their individual bill. Once for the services received by the physician, the other from the hospital or facility. But as coders and auditors, how do we keep up with what can and cannot be billed to each location? Or which modifiers we’re allowed to use? Or which E/M services we should report for provider-based clinic billing?

To help any of you who were recently acquired by a hospital or, conversely, recently acquired a physician practice, we’re going to be hosting a webinar to dive into the nitty-gritty of everything provider-based billing.

Webinar Details Here >>

Questions or Comments?