Facility Billing

Facility Billing Services

Hospital, facility, or institutional billing deals only with the medical billing process, not with medical coding, whereas physician billing includes medical coding.

Being an expert in this field, we confidently assert our capability to deliver comprehensive solutions for facility billing. These claims are primarily billed on behalf of hospitals, Freestanding ERs, Outpatient Drug Rehab Facilities & Ambulatory surgery centers.

Facility billing is submitted on UB04 forms, which need rev codes. The UB-04 is the paper version, and the 837-I form remains the electronic version. “I” stands for the institutional configuration.

Facility billing or Institutional billing deals with claims for procedures or work executed by institutions like nursing facilities, hospitals, and several organizations for inpatient and outpatient administrations also includes usage of equipment and supplies, radiology services, laboratory services, and various charges.

Facility coding is based on resources utilized by the facility, unlike professional codes that are based on complexity. There are 81 fields in UB04. Some of them include:

  • Billing Provider Site Information: Pls select the site you are billing for if more than one is available for choice in the drop-down box.
  • Pay to Provider: Only utilize if submitting a paper formatted UB04.
  • Patient Control Number: This is optional.
  • Medical Record Number
  • Bill Type: This is mandatory that includes three parts; “0”, the Facility Type Code, Bill Frequency Type Code. Two digits after zero mean facility type.

ER Visits

Billing for ER visits by patients cover diagnostic and therapeutic services provided, including:

  • Facility use (including all nursing care) & professional billing
  • Equipment, laboratory, radiology, supplies, pharmaceuticals, and other services incidental to the emergency room visit. Reimbursement for emergency room services relates to the emergency diagnosis and can be based on urgent care rates, depending on the diagnosis.

Outpatient Surgical Services

The billing requirements for outpatient surgical services apply to each outpatient hospital visit for outpatient surgery services, including, but not limited to:

  • Facility use (including all nursing care)
  • Equipment, supplies, pharmaceuticals, blood, laboratory, radiology, imaging services, implantable prostheses, and all other services incidental to the outpatient surgery visit.