Controversies in Billing for Clinical Services - American Society of ...

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Methods for Reimbursement Incident to Physician Services – Criteria for use Integral component of the physician’s diagnosis and treatment Provided under direct supervision of physician Employee of the physician (this was removed) Ordinarily done in a physician’s office / clinic Services must be documented and medically necessary in order for payment to be made
Methods for Reimbursement Outpatient Prospective Payment System – Only for hospital-based hospital based clinics – Two components to the fee Professional Fee Technical Fee or “Facility Fee” – Utilizes the APC codes (600, 601, 602) – Hospital gets to define the code criteria – Reimbursement is made to the hospital
Page 1 and 2: Controversies in Billing for Clinic
Page 3 and 4: Recent Milestones Affecting Billing
Page 5 and 6: Recent Milestones Affecting Billing
Page 7 and 8: Clinical Pharmacy Services & MTMS E
Page 9 and 10: Justification for Clinical Services
Page 11 and 12: Justification for Clinical Services
Page 13 and 14: Methods for Reimbursement Methods f
Page 15 and 16: Methods for Reimbursement Medicare
Page 17 and 18: DME (durable medical equipment) Med
Page 19 and 20: MTMS: New Advances in DIRECT Billin
Page 21: Methods for Reimbursement Incident
Page 25 and 26: Sample UB-92 UB 92 Form 42 Rev CD 4
Page 27 and 28: “Superbills Superbills” Superbi
Page 29 and 30: Methods for Reimbursement CLIA-waiv
Page 31 and 32: Methods for Reimbursement Medicaid
Page 33 and 34: Methods for Reimbursement Third Par
Page 35 and 36: Methods for Reimbursement Payer - M
Page 37 and 38: Methods for Reimbursement Methods f
Page 39 and 40: Billing in Hospital-Based Hospital
Page 41 and 42: Billing in Hospital-Based Hospital
Page 43 and 44: Billing in Physician Clinics Bill f
Page 45 and 46: Methods for Reimbursement Community
Page 47 and 48: Reimbursement Controversies Pharmac
Page 49 and 50: Where are we headed? �� Direct
Page 51 and 52: Billing Scenarios: Medicare MD Offi
Page 53 and 54: Billing Scenarios: Medicare R.Ph. s
Page 55: Billing Scenarios: Medicare If the

Controversies in Billing for Clinical Services - American Society of ...

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