Medicare Compliance & Reimbursement

Question: My provider sees Medicare beneficiaries in other facilities outside our office. I’m trying to nail down my coding of place of service (POS) for Medicare claims, but I’m having trouble figuring out which facilities count as facilities, per the Centers for Medicare & Medicaid Services (CMS); versus what facilities are, indeed, facilities but don’t count as such, in terms of coding POS. For example, is there a difference between skilled nursing facility (SNF) and nursing facility, when submitting claims?

Washington, DC Subscriber

Answer: SNFs and nursing facilities, familiarly known as nursing homes, both have “facility” in their names, but CMS pays different rates for services performed in each.

According to Medicare Claims Processing Manual, Chapter 26, Section 10.5, CMS pays SNFs a “facility” rate and nursing homes a “nonfacility” rate.

CMS defines an SNF as “a facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital,” and a nursing facility as “a facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than individuals with intellectual disabilities.”

The POS code for SNFs is 31 and the POS for nursing facilities is 32.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC