Wiki physician billing IP services, facility billing OBS

[Lorijo]

Hi everyone,

I have a claim that denied because of the POS reported. When I researched the claim, the facility claim was downgraded form IP to OBS service. Should all the services provided on those dates be reflected as OP services on the physician side? If I update the POS on the denied claim in my worklist, but I don't correct the related claims billed for the same stay, isn't this a compliance issue? Shouldn't the physician services mirror what the facility billed as far as the POS reported? The client is telling me to just update the POS on the denied claim, and wait to see if the carrier retracts the payments for the related invoices.

Thank you,
Lori

 

[thomas7331]

If you know that the POS is observation, then the best practice is to correct all of your claims, both the POS and the CPT codes, to reflect the new information. In my experience, it's better to do it up front rather than wait for denials or retractions, as any additional delays can get you into issues with timely filing and end up creating even more work for you and potential loss of revenue for the providers.