Wiki Changing POS to make the 2nd Insurance Happy

[helehcim]

I work for a billing company and one of our practices bills orthotics to DMERC with POS 12 (obviously) but some secondary insurances want the place of service code to be 11. Meaning they want us to change the POS before submitting the claim to them for secondary payment otherwise they simply deny the claim. The denials state we cannot bill the patient. This irks me to no end but that's another thread, isn't it

My co-workers seem to think it's fraud to change any part of a claim before submitting it to the secondary insurance. The secondary insurance company says it is not. I feel it's not accurate to change the POS since the DME is to be used in the home and the patient simply picked the device up at the office AND the primary insurance has processed the claim with POS 12 already.

Can someone direct me to documentation where I can see if this is fraudulent or not?

Thank you
Michele

 

[Kirstyn20]

I do not have a clear answer for you, but we also bill our DMERC charges with POS 12 and I haven't had a 2ndary payer deny for POS and want us to change it. I think that is odd!!! What 2ndary is doing that??

 

[helehcim]

It's BCBS of some random state (I'm at a billing company so I don't get copies of the cards sometimes, like in this case). I've researched it some and CMS says to check with each carrier to see what they require.

 

[belindapearl]

We have always had to change the pos for gm retirees. Their bcbs number should start with gmh. We used to have to send all dme claims to Norwood instead of bcbs, which was a nightmare. I do not feel that it is wrong to change the pos to satisfy the insurance company, different insurances just want it billed differently.