Friday, May 13, 2016

Ambulatory Surgical Center billing basic for beginners

Outlined below are generally accepted billing guidelines. This listing is illustrative only and is not intended to be all-inclusive.

• Submit one bill to Florida Blue for all services provided on the day, or within 72 hours, unless otherwise specified in your contract, of a performed surgical procedure.

This includes all charges for pre-operative testing.

• No interim or split bills.

• Include charges for pre-operative testing related to surgery on the same bill as the surgery, whether or not the testing was provided on the date of surgery. The span date should reflect the date of the testing through the date of the surgery. The From Date and Admission Date will be the same if pre-operative services were performed.

• Submit the date of service on each detail line.

• Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System ( HCPCS codes must be reported on each detail line when the revenue code is one of the codes listed here.

• Appropriate modifier codes should be reported for accurate application of Correct Coding Initiative (CCI) edits.

• Bill physician/professional fees on a CMS-1500 form only.

Behavioral Health Outpatient Clinic Groups

Behavioral Health Outpatient Clinic (BHOC) groups are comprised of outpatient clinics that provide professional services performed by Licensed Clinical Social Workers (LCSWs), Behavioral Analyst Doctorate (BCAD), Board Certified Behavioral Analyst (BCBA), Board Certified Assistant Behavioral Analyst (BCaBA), Licensed Marriage and Family Therapists (LMFT), Licensed Mental Health Counselor (LMHC), associated with Psychiatric and Substance Abuse (PSA) facilities and Community Mental Health Centers (CMHC).

BHOCs should be billing with place of service ‘11’.

The Facility’s NPI number should be placed in block 24J and in block 33a. The individual rendering master level clinician NPI number is not needed for these claims.

IMPORTANT: LMHC and LMFT license types are excluded from seeing Medicare members. Providers participating in the New Directions Behavioral Health network should follow billing guidelines as instructed by New Directions via their website at If there are any questions, New Directions can be contacted by phone at 1-888-611-6285.

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