Does accreditation status result in the ability of an office-based surgical practice (OBS practice) to receive a “facility fee”?
Accreditation status alone does not require a third party insurer to pay a facility fee. Whether a third party insurer will pay a facility fee is a matter of negotiation between the insurer and the OBS practice. Neither Medicaid nor Medicare will pay a separate facility fee for OBS. 44. Can an OBS practice bill third party insurers for a facility fee under a different corporate entity such as a business corporation or a professional corporation? [Revised as of June 5, 2008] No, this might be illegal if the rate has not been negotiated with the third party insurer. In order to collect the facility fee, the different corporate entity, with its own taxpayer identification number, might be holding itself out as a professional entity. Under State Education Law (SEL) 6513, the unauthorized use of a professional title is a crime. In addition, this might also be considered billing fraud. Both of these possible criminal actions might affect the entity billing the facility fee as well as the OBS
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