Facility Billing
Facility billing is not as similar as billing for a regular doctor or specialist; it is a type of billing that compasses billing insurance for hospitals, inpatient or outpatient clinics, and other offices like ambulatory surgery centers. It represents tools, equipment and other health care resource utilizations. Various facility services are sanctioned on discrete facility claim forms to different entities for processing, based on payer requirements.
A single facility claim is generated for all health care services given to the patient on that date of service. Each facility claim contains:
- Condition code Go Distinct medical visit is submitted in the claim header, this helps the payer understand that the evaluation and management (E/M) codes are different, potentially reimbursable services, and not duplicates.
- The occurrence code and occurrence date at the header level represents some of the services were associated to an accident, which enables the payer know other medical coverage may apply for the services on the claim.
- Revenue codes specify the facility department or area (e.g., 450 for the ER).
- HCPCS Level II/CPT® codes
- Diagnosis codes shown at the header level, not tied to a specific line.
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