This page addresses follow-up questions and additional information pertinent to our webinar
Facility vs. Profee: A Tale of Two Claims.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: Why do bundled services look different on each claim?
A: Physicians bill what they did. Hospitals bill what resources were used.
Q: Why do modifiers differ between hospital and professional claims?
A: Because they serve different purposes – professional modifiers describe provider work, while facility modifiers describe billing and packaging.
Q: Shouldn’t the hospital and doctor bill the same thing?
A: No. The provider codes their own claim and the hospital codes its own claim. They are reviewed and paid separately.
Q: Is split billing the same as provider-based billing?
A: Not exactly. Provider-based billing describes a facility type where clinics are part of a hospital, and split billing is the method used to bill for services in those provider-based settings, creating separate claims for the facility (technical) and the doctor (professional). In short, provider-based billing creates the scenario, and split billing is the resulting billing practice.
Meet the Presenters: Shea Lunt, RHIA, CPC, CPMA & Theresa Rosa, MSIT-HI, RHIA, CCS
Shea is a Director of Coding Quality & Compliance for The Haugen Consulting Group with 15 years of health care industry experience. Shea has experience working on the professional fee side of coding, auditing, education, and compliance serving coders and physicians. Shea has also served as a project lead for ICD-10-CM education initiatives and implementation of computer assisted coding (CAC) projects.
She earned a bachelor’s degree in health information management and a master’s degree in health services administration from the University of Kansas Medical Center in Kansas City, Kansas. Shea is a Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), and Certified Professional Medical Auditor (CPMA).
Theresa brings more than 15 years of experience in health information management and coding to her role at Haugen Consulting Group. Her career spans leadership roles, where she developed a reputation for excellence in compliant coding and documentation practices, revenue cycle optimization, and coder education.
As a Certified Coding Specialist (CCS) and Registered Health Information Administrator (RHIA), Theresa has overseen inpatient and outpatient coding operations, conducted high-level audits, and led staff development initiatives across multiple medical centers. She has provided policy guidance and coding oversight nationally, co-chairing the VHA National Coding Council and being a subject matter expert for the VHA HIM Program Office.
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