Office-based procedures
Applies to:
All plans
Definition
Office-based procedures are those provided by a physician in the practice office setting. They are reimbursed using the resource-based relative value scale (RBRVS), a physician payment system that takes three components of service cost into account: physician work, practice expenses and malpractice expenses.
Reimbursement by Priority Health
To encourage the use of office-based procedures, Priority Health pays The RBRVS site-of-service payment differential on procedures performed in an office place of service when performed by accredited physicians.
- ACA non-payment grace period
- Ambulatory surgery center billing
- Balance billing
- Clinical edits
- Check reissue procedure
- COB: Coordination of benefits
- Correcting claims
- Correcting overpayments & underpayments
- Diagnosis coding
- Drug Coverage
- Dual-eligible members
- Front-end rejections
- Gender-specific services
- Medicaid billing
- Modifiers
- NDC numbers on drug claims
- Office-based procedures billing
- Risk adjustment
- Unlisted codes, drugs & supplies