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Facility vs. Nonfacility

Facility vs. Nonfacility

Question: I have been asked to get a Medicare 2004 fee schedule together. I used your web site and was able to do a nice job — thanks so much. But when is the facility charge used and when is the nonfacility charge used?

Answer: If you're a typical private practice and own your own facility, then don't pay any attention to the facility columns in the Medicare Fee Schedule.

In layman's terms, facilities are hospitals, skilled nursing facilities, nursing homes, or any other place that bills for Medicare Part A. Some physicians work out of a hospital-owned facility — they're employed by and work in a facility owned and billed for by a hospital — and those physicians would be billing based on the facility rates. Generally speaking, facility rates for physicians' services are lower than nonfacility rates because the hospital is also billing a "facility charge" to Medicare Part A. But again, if you work in your own office, don't worry about it.


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