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Inpatient Facility Coding & Compliance Alert

Reader Question:

An Inpatient Is Always an Inpatient for POS

Published on Fri Dec 21, 2012

Question: One of my coworkers heard that some Medicare rules have changed regarding whether face-to-face time can change a patient’s inpatient/outpatient status when a radiologist is involved. What is she talking about?

Maine Subscriber Answer: Your coworker probably is referring to the situation when determining the proper place of service to list on the claim can be sometimes be tricky when you’re billing radiology’s interpretation and report. The good news is that new CMS guidance will set you straight. The latest Medicare rule states that the POS code you put on the claim needs to reflect the "setting in which the beneficiary received the face-to-face service," according to MLN Matters MM7631. CMS has created exceptions to the rule, however, so be sure to read the rule in full and pay attention to each element. The article indicates two exceptions to the rule that the face-to-face service location [...]
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