Accreditation and Billing for Office Based Surgery (OBS)

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
December 18th, 2017

The traditional healthcare has seen many changes over the years, one of the newest changes we are seeing is procedures once being done as an inpatient, then as an outpatient and now from the outpatient facility to Office-Based procedures. For an Office or Provider to be eligible to perform Office-Based Surgery the Joint Commission established an Office-Based Accreditation in 2001.  This accreditation is used to serve as a quality oversight tool for small office-based surgical practices. 

There are several benefits of OBS. It can increase a provider's competitive edge as the charge for OBS procedures will not include the expenses that a facility need to charge,and it is seen as a commitment to a higher level of patient safety and patient care.  Managed care contracts may be a little easier to negotiate due to a slightly lower reimbursement rate. OBS is not considered a facility and will not be paid as a facility, not to mention the convenience and economic advantage of the patient that also allows the physician to be in his own office.

It goes without saying the practice must have a license or registration to conduct its scope of services.  There are other requirements by the Joint Commission to be eligible, for further information see the topic page Facts about Office-Based Surgery Accreditation.

The State of New York, Department of Health stated, "Effective February 17, 2014, podiatrists privileged to perform ankle surgery by the State Education Department must comply with the OBS law if they perform such surgeries in a private practice office utilizing more than minimal sedation or local anesthesia."

To determine what type of medical claim form you should use to report your claims with, consider the following with your Accreditation: 

How are you Accredited? 

If your accreditation is as an ASC you would bill under POS 24 with a CMS-1450 (UB-04) and you must a bill as a facility licensed practice.   

If your accreditation is not under a facility or ASC, you would bill with the Place of Service (POS) 11 (Office) and use a CMS-1500 claim form.  If the office is not licensed and certified as an ASC it should not bill as an ASC but as an office. 

Ref:

Office-Based Surgery (OBS)Frequently Asked Questions (FAQ's) for Practitioners for the State of NY

Public Health Law

List of accredited agencies In NY

Joint commission Office-based Surgery Accreditation

List of accredited agencies In NY

 

References:

Accreditation and Billing for Office Based Surgery (OBS). (2017, December 18). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/billing-for-office-based-surgery-obs-32651.html

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