Medical practices can feel as diverse as people at times with regards to available arrangements and agreements between the different facilities and physicians. Because so many fiscal arrangements exist, medical entities have to bill their charges based on which level of service that entity is offering their clients. The CMS has made billing rules made to accommodate for varying levels of service. This was done by standardizing medical billing for the insurance industry as a whole. If a biller can comprehend what CPT-4 codes are, as well as modifiers, they can bill to CMS standards, resulting in fewer denials.
The NHIC (National Health Information Center) sees that people need more training. Specifically, there are problems with billing modifiers necessary for differentiating global, technical, and pro-fee billing. This is how CMS distinguishes between global, technical, and pro-fee billing.
What Is Pro-Fee Billing?
The pro-fee billing aspect of a charge only includes the expenses needed for those professional services. If you are billing for a physician’s time and skills, you want to add a 26 modifier to specific CPT codes. An example would be if a patient undergoes a CT scan and has a doctor interpret the results for them. The biller in this scenario would use the code 77014-26 to tell others that only the professional services are charged. Pro-fee billing is used when charging solely for the services of a professional.
What Is Technical Billing?
Unlike pro-fee billing, technical billing is used when paying for the use of facilities, their gear and other supplies. Technical billing does not include the expenses of a professional physician’s services, but it does include the other services that have to do with the visit. Referring back to our CT scan exemplar, a biller could code 77014-TC to say that only technical charges will be used. This indicates that the medical claim only wants payment for the use of the equipment involved with the CT scan, as well as the costs connected to the supplies and staff (except for the physician).
What Is Global Billing?
Global billing is done when there isn’t a division of expenses within a medical service since the service was given by one entity alone. Global billing includes both pro-fee billing and technical billing aspects. It doesn’t use a modifier. A coding example would be if a patient had a consultation with their doctor. A biller could code 99023, and they would not use a modifier like with pro-fee billing or technical billing.
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