Increased reimbursement for office-based procedures
As part of our commitment to helping you provide excellent, affordable care to your patients, we’re increasing reimbursement for certain procedure codes to encourage more office-based procedures.
As of July 1, 2011, we began paying an increased office-based reimbursement for selected procedures that don’t currently have site-of-service payment differentials between facility and non-facility place of service locations. We have updated our standard fee schedules to include this provision.
When you provide services in your office for the procedures with new site-of-service differentials you’ll be reimbursed the current physician professional component plus a facility component equal to the National CMS Ambulatory Surgery Center fee.
To qualify for this reimbursement, providers must have accreditation for performing office-based procedures. Michigan Quality Improvement Consortium (MQIC)-acknowledged accreditation organizations include:
- American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)
- Accreditation Association for Ambulatory Health Care (AAAHC)
- The Joint Commission (TJC)
- American Osteopathic Association Health Care Facilities Accreditation (AOA HCFA)
If a provider lacks proper accreditation, Priority Health will take back payment for each office-based procedure claim. To receive an updated copy of the Priority Health fee schedule, please contact your provider account coordinator. You may reach them directly or through the Provider Helpline at 800 942-4765.
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