Medical Billing - FA0 Record Overview

The meat and potatoes of medical billing, when all is said and done, is the actual service that is being billed. This can be a procedure, piece of equipment, tests, anything. This information, when billing electronically, is transmitted in the FA0 record, which just happens to be the longest record in the NSF 3.01 specifications and for good reason.

Because of the large number of items that can be billed to a payer, there are many things that need to be taken into account. For example. If you're billing for oxygen therapy, you're dealing with a variety of items here. For starters, you're dealing with the actual equipment, such as the oxygen tank, but you're also dealing with the oxygen itself, which believe it or not, is also billable. The more oxygen units you use, the more your bill will be.

Another example would be if you're billing for a procedure such as a mammogram. This is a very specialized procedure and must also be accounted for. Therefore, a place in the FA0 record must also be reserved for special procedures like these.

Even things as simple as blood tests have to be accounted for and billed accordingly. Therefore, a place in the FA0 record must also be reserved for specific information related to these blood tests.

Then of course, there is the issue of items that are purchased and items that are rented. For example. A patient may put in a purchase for test strips for testing their diabetes. This is a purchase item, but if a patient is on oxygen, the oxygen tank is rented and must be billed accordingly. The actual oxygen is treated separately as a purchase item, so in the case of a person on oxygen you have a duel rental and purchase charge.

Then there is the matter of how these items are actually billed and for how much. Each item has what is called an allowable amount. This is an amount that is set up by standards and is the amount that the patient or provider is entitled to and no more. The provider can bill for whatever he wants but ultimately, he is going to be paid whatever the allowable is for that item or service. This information must also be transmitted in the FA0 record when billing each item.

Then there is the issue of what can be billed together and what has to go separately in another FA0 record. The way the FA0 record system works is simple in theory. All purchase items must go together and all rental items must go together. Therefore, that means there will be a minimum of two FA0 records if a patient has both rental and purchase items. However, all items must be billed by date as well, with each date being on a separate FA0 record. In the matter of oxygen, where the units are billed monthly, this can get quite complicated and generate a number of FA0 records.

In the next installment in this series on the FA0 record, we'll cover the actual fields of the record itself.

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Michael Russell Your Independent guide to Medical Billing

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