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Wiki Surgery Center
- Thread starter Klynch49
- Start date
SharonCollachi
Guest
The POS is not predicated on Medicare approval.
FAQ for New CMS Rules for
Place of Service Codes (POS)
on Claims for Services After
April 1, 2013
CMS has clarified the Place of Service (POS) codes that
Physicians/Providers are to use on claims for services to
patients starting April 1, 2013. This is more than a simple
technical requirement, however. The correct place of service
is directly tied to how much a physician/provider is
compensated. Keep in mind that the professional fee (the
physician/provider part) is different based on whether the
service is provided in a non-facility setting (not the
hospital) or a facility setting (the hospital.)
Q: What is the rule for choosing the POS for physician
services?
A: The POS code to be used by the physician and other
suppliers will be the same setting in which the beneficiary
received the face-to-face service.
Q: How does the rule apply to the interpretation (reading) of
diagnostic tests?
A: When a physician/practitioner provides the Professional
Component (PC)/interpretation of a diagnostic test from a
different/distant site, the POS code assigned by the physician
/practitioner will be the setting in which the beneficiary
received the Technical Component (TC) of the service.
Example: A patient receives an MRI at an outpatient hospital
near his/her home. The hospital submits a claim that would
correspond to the TC portion of the MRI. The physician
furnishes the PC portion of the beneficiary’s MRI from his/her
office location – POS code 22 will be used on the physician’s
claim for the PC to indicate that the beneficiary received the
face-to-face portion of the MRI, the TC, at the outpatient
hospital.
Q: Are there any exceptions to the rule?
A: There are two exceptions: The physician should always uses
the POS code where the beneficiary is receiving care as a
hospital inpatient (POS code 21) or an outpatient of a
hospital (POS code 22) regardless of where the beneficiary
encounters the face-to-face service. The Medicare Claims
Processing Manual already requires this for physician services
(and for certain independent laboratory services) provided to
beneficiaries in the inpatient hospital; the new policy
clarifies this exception and extends it to beneficiaries of
the outpatient hospital, as well.
In other words, reporting the inpatient hospital POS code 21
or the outpatient hospital POS code 22, is a minimum
requirement for purposes of triggering the facility payment
under the PFS when services are provided to a registered
inpatient or an outpatient of a hospital respectively.
The list of settings where a physician’s services are paid at
the facility rate include:
Inpatient Hospital (POS code 21)
Outpatient Hospital (POS code 22)
Emergency Room-Hospital (POS code 23)
Medicare-participating Ambulatory Surgical Center (ASC)
for a Healthcare Common Procedure Coding System (HCPCS)
code included on the ASC approved list of procedures
(POS code 24)
Medicare-participating ASC for a procedure not on the
ASC list of approved procedures with dates of service on
Place of Service Codes (POS)
on Claims for Services After
April 1, 2013
CMS has clarified the Place of Service (POS) codes that
Physicians/Providers are to use on claims for services to
patients starting April 1, 2013. This is more than a simple
technical requirement, however. The correct place of service
is directly tied to how much a physician/provider is
compensated. Keep in mind that the professional fee (the
physician/provider part) is different based on whether the
service is provided in a non-facility setting (not the
hospital) or a facility setting (the hospital.)
Q: What is the rule for choosing the POS for physician
services?
A: The POS code to be used by the physician and other
suppliers will be the same setting in which the beneficiary
received the face-to-face service.
Q: How does the rule apply to the interpretation (reading) of
diagnostic tests?
A: When a physician/practitioner provides the Professional
Component (PC)/interpretation of a diagnostic test from a
different/distant site, the POS code assigned by the physician
/practitioner will be the setting in which the beneficiary
received the Technical Component (TC) of the service.
Example: A patient receives an MRI at an outpatient hospital
near his/her home. The hospital submits a claim that would
correspond to the TC portion of the MRI. The physician
furnishes the PC portion of the beneficiary’s MRI from his/her
office location – POS code 22 will be used on the physician’s
claim for the PC to indicate that the beneficiary received the
face-to-face portion of the MRI, the TC, at the outpatient
hospital.
Q: Are there any exceptions to the rule?
A: There are two exceptions: The physician should always uses
the POS code where the beneficiary is receiving care as a
hospital inpatient (POS code 21) or an outpatient of a
hospital (POS code 22) regardless of where the beneficiary
encounters the face-to-face service. The Medicare Claims
Processing Manual already requires this for physician services
(and for certain independent laboratory services) provided to
beneficiaries in the inpatient hospital; the new policy
clarifies this exception and extends it to beneficiaries of
the outpatient hospital, as well.
In other words, reporting the inpatient hospital POS code 21
or the outpatient hospital POS code 22, is a minimum
requirement for purposes of triggering the facility payment
under the PFS when services are provided to a registered
inpatient or an outpatient of a hospital respectively.
The list of settings where a physician’s services are paid at
the facility rate include:
Inpatient Hospital (POS code 21)
Outpatient Hospital (POS code 22)
Emergency Room-Hospital (POS code 23)
Medicare-participating Ambulatory Surgical Center (ASC)
for a Healthcare Common Procedure Coding System (HCPCS)
code included on the ASC approved list of procedures
(POS code 24)
Medicare-participating ASC for a procedure not on the
ASC list of approved procedures with dates of service on
SharonCollachi
Guest
I'm not sure how that answers the question. They aren't looking for Medicare info, it appears, because the ASC is not Medicare-approved. So why would CMS's opinion have any weight on this?