Medicare Compliance & Reimbursement - 2013 Issue 44
Reader Question: Don't Expect Separate Hospital Reimbursement For 96103
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Article Overview
This article addresses a billing question involving a hospital-based practice and a computer-administered psychological testing service. It explains the general relationship between professional and technical components, discusses when facility billing may be considered, and notes the role of separately identifiable evaluation-and-management services and an associated modifier in the hospital setting. The piece is aimed at coders, billers, and revenue-cycle staff who handle outpatient hospital and professional claims.
Why This Topic Matters
Hospital-based billing can differ from office-based billing, and misunderstanding how a testing service is reported may lead to incomplete or incorrect claim submission. The article helps readers understand the general billing context for this type of service and when another service may be considered separately.
What You Will Learn
- How a hospital-based practice context affects billing considerations for a psychological testing service
- The general relationship between professional and technical components in this type of service
- When facility billing and evaluation-and-management billing may come into play
- Why payer contracts can affect whether an additional hospital charge is paid
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Outpatient hospital billing staff
- Behavioral health practice administrators
Codes Discussed
Modifiers Discussed
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