Facility vs. Profee: A Tale of Two Claims

Description

The line between facility and professional (profee) coding is clear — in theory — but in practice, it’s one of the most common areas of confusion in healthcare billing. Knowing who is billing, what services are being billed, and how they’re being reported can significantly impact reimbursement, documentation accuracy, and audit risk. This webinar will provide a clear, practical breakdown of the key differences between facility and professional coding, including how each is billed and documented. We’ll address common pain points such as E/M leveling criteria, source documentation, modifier usage, and the differences between UB-04 and CMS-1500 claim forms.

Objectives:

• Differentiate between facility and professional coding in terms of purpose, billing forms, and coding methodologies
• Identify the types of services and components billed under each coding model
• Define documentation requirements and describe coding responsibilities for both facility and professional (profee) claims
• Recognize common scenarios involving dual billing (e.g., hospital outpatient visits and ED encounters)
• Apply correct use of modifiers such as -26 (professional component) and -TC (technical component)

View webinar Q&A: https://www.thehaugengroup.com/facility-vs-profee-a-tale-of-two-claims/

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