Update POS Reporting Practices for 5010

Effective Jan. 1, 2011, correctly reporting on claims the address for where a service payable under the Medicare Physician Fee Schedule (MPFS) or an anesthesia service was provided when the place of service (POS) is home will be more important than ever. Providers will be required to include this information on the 5010 version of the ANSI X12N 837 P electronic claim form, which becomes available for testing the first of the year, or they will see claims returned unprocessed.

For claims processed on or after Jan. 1, 2011 on the 5010 version of the ANSI X12N 837 P electronic claim form, Medicare contractors will return unprocessed claims for services payable under the MPFS and anesthesia services when rendered in POS home (or any POS they consider home) if submitted without the service facility location.

For claims processed on the CMS-1500 paper claim form on or after Jan. 1, 2011, Medicare contractors will return unprocessed claims for services payable under the MPFS and anesthesia services rendered in all POS (including home) if submitted without the address of where the service was performed in Item 32.

Medicare contractors also will return unprocessed claims for services payable under the MPFS and anesthesia services submitted on or after Jan. 1, 2011 on the CMS-1500 claim form when more than one POS code is on the claim.

CMS Transmittal 2041, CR 6947, dated Aug. 31, replaces Transmittal 2015, dated July 30, to incorporate this manual change in chapter 26, section 10.4.

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