E/M Coding Alert - 2015 Issue 6
Reader Questions: Distinguish Facility vs. Non-Facility Fees
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Article Overview
This reader Q&A addresses the difference between facility and non-facility professional fee payment in the context of hospital outpatient billing. It is written for coding and billing professionals who need to understand how place of service affects Medicare reimbursement and related fee selection. The article includes a brief explanation of the general concept, the applicable place of service codes, and an example showing how payment can differ by setting.
Why This Topic Matters
Accurate place of service reporting can materially affect Medicare payment, so coders and billers need to distinguish when facility-based versus non-facility-based professional fees apply.
What You Will Learn
- How place of service affects professional fee billing in outpatient settings.
- The general distinction between facility and non-facility payment structures.
- Which place of service contexts are discussed in relation to Medicare fee adjustment.
- How an example code can illustrate payment differences by setting.
Who Should Read This
- Medical coders
- Medical billers
- Physician practice administrators
- Revenue cycle staff
- Compliance staff
Codes Discussed
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