Distinguish between professional and facility charges and give examples of how each appears in an EPIC Resolute claim.

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Multiple Choice

Distinguish between professional and facility charges and give examples of how each appears in an EPIC Resolute claim.

Professional charges represent what the physician or other clinicians bill for their services, and they are coded with CPT/HCPCS codes. In an EPIC Resolute claim, these appear as line items described by CPT/HCPCS codes, with units and the physician’s charge shown for each service. Facility charges cover the hospital's costs to provide care—things like room and board, nursing, labs, imaging, and other use of the hospital’s facilities. These are reported using revenue codes on the claim (the UB-04 style groupings), not CPT/HCPCS codes. In EPIC Resolute you’ll see separate facility line items driven by revenue codes that describe the hospital services. So, the correct idea is that professional charges map to CPT/HCPCS codes for physician services, while facility charges map to revenue codes for hospital services. This distinction is what lets payers apply the right payment rules to the physician work versus the facility costs. For example, a physician’s office visit would appear as a professional charge with a CPT code (like an E/M code), while the hospital’s room charge or a lab test would appear as a facility charge with a revenue code describing the service category.

Professional charges represent what the physician or other clinicians bill for their services, and they are coded with CPT/HCPCS codes. In an EPIC Resolute claim, these appear as line items described by CPT/HCPCS codes, with units and the physician’s charge shown for each service.

Facility charges cover the hospital's costs to provide care—things like room and board, nursing, labs, imaging, and other use of the hospital’s facilities. These are reported using revenue codes on the claim (the UB-04 style groupings), not CPT/HCPCS codes. In EPIC Resolute you’ll see separate facility line items driven by revenue codes that describe the hospital services.

So, the correct idea is that professional charges map to CPT/HCPCS codes for physician services, while facility charges map to revenue codes for hospital services. This distinction is what lets payers apply the right payment rules to the physician work versus the facility costs. For example, a physician’s office visit would appear as a professional charge with a CPT code (like an E/M code), while the hospital’s room charge or a lab test would appear as a facility charge with a revenue code describing the service category.

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