Wiki 92586 Newborn Hearing Screening POS

[Pwhiston]

We are a group audiologists who provide newborn hearing screenings in several hospitals before the infant is discharged. Some payers include our services in the DRG even though we are not employed by the facility nor do we use any of their staff, equipment or supplies. Do we have to use POS 21 for inpatient hospital, or can we use POS 81 for a laboratory certified to perform diagnostic and/or clinical tests independent of an institution or physicians office? Some providers are using the POS 81 and being reimbursed by the same payers that include our services in the DRG.

 

[JenniferB7]

Reimbursement for inpatient newborn hearing screenings are included in the facility newborn DRG payment. You cannot bill separately for these services even though you are independent and not employed by the hospital. If your audiologists are providing services in the inpatient hospital, then POS 21 is correct. You cannot use POS 81 since an inpatient hospital is not a certified laboratory (though the hospital may have an outpatient, certified lab), which is what POS 81 refers to. It could be considered fraud to use POS 81 to obtain payment for services that are bundled in the DRG payments.

https://www.supercoder.com/my-ask-an-expert/topic/newborn-hearing-screenings-92586
http://www.tmhp.com/HTMLmanuals/TMPPM/2011/2011TMPPM-19-344.html (sample Medicaid policy for Texas)

To receive reimbursement, your group would need a contractual agreement with each inpatient facility where your audiologists perform newborn hearing screens and arrange for direct payment from the inpatient facility for those services. Hope that helps!