[lightbox link=”https://columbusohmedicalbilling.com/wp-content/uploads/2015/03/gavel.jpg” thumb=”https://columbusohmedicalbilling.com/wp-content/uploads/2015/03/gavel-300×218.jpg” width=”300″ align=”left” title=”gavel” frame=”true” icon=”image”]What qualifies a healthcare organization to bill facility fees? Avanguard Medical Group, Woodhaven, New York, learned the answer the hard way.
The practice tried for years to collect facility fees from no-fault insurers for the use of its Brooklyn office, where office-based surgeries are performed. GEICO repeatedly denied their claims, and a court battle ensued.
The NY Court of Appeals ruled, Feb. 18, in favor of GEICO on the basis that only providers duly licensed under Article 28 of the Public Health Law are authorized to bill no-fault carriers for office-based facility fees.
It would be “improper,” the court said, to determine that a facility such as Avanguard is entitled to the same benefits as hospitals and ASCs, “when it is not subject to the significant regulatory burdens and costs of that article.”
A facility fee is a charge for the use of a medical facility and its staff and equipment. This fee is separate to the fee a qualified healthcare provider can charge for his or her services.