Wiki Confused about POS

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jcdavis2007

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I am a new coder in a duel medical practice. We have a Urgent Care and a family practice ran out of the same building (using the same receptions and Physicians). Sometime when a patient that has been seen before comes in they give incorrect information to the front-desk and are put in the wrong facility this making their claims be denied for payment by the insurance company. My manager is a certified coder also and is wondering if the provider puts an addendum in the chart about the chart being open in the wrong facility can the POS be changed? We bill urgent care with 20 and Family practice with 11. I get calls from patients and insurance company's asking us to change the POS all the time. My originally thinking is that we have to bill what the chart is open in. After the patient come through the door from the waiting room there is no difference in the two clinics. The problem lies with the HMO who our Dr. is not the PCP can be seen in urgent care only. Can we put the addendum in chart and legally change the POS and re-submit the claim to insurance. This is to help the patient get coverage by their insurance. The patient thinks they can be seen in the family clinic because they have been seen by a physician that is in our family practice, not realizing that he works both the family practice during the day and urgent care at night and weekends:eek:
 
Pos

Hi, my name is Sandra work for the payor side as System Configuration Analyst, I'm also a CCS license and a Claims Examiner/Auditor.

Putting an addendum to the patient chart is a good practice and also support your claim for correction and future Audit, make sure to have doctor date and sign.

If your having the same problem with the same insurance/payor I suggest to pick up the phone and let them know that the provider of service works for both Family Practice (11) and an Urgent Care Facility (20), in this way they could put an alert in their system to the examiner that this provider practices for both location. Direct your call to the Contract Department/Supervisor or Manager.

As far as the patient, patient/member usually are not knowledgeable of what benefits they have, you or the person in charge just need to do some explaining to what is covered and what's not covered.

Hope this help...
 
We also have an urgent care and multi-specialty in the same building. However,our UC has the same tax id # and is staffed by physicians who only work that dept. It is open later than the main clinic and on weekends, but is considered more of an over-flow walk-in clinic. We use the same pos for each setting as the UC is not a free-standing UC.
 
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