Wiki E & M requirements for billing outpatient using POS 22

[dhudd821]

We are an Oncology practice that has just entered into a Co Management agreement with our local hospital. Our outpatient infusion center will be moving to the hospital campus and the hospital will be submitting all Infusion charges. Our practice will retain our TIN and NPI numbers. We will continue to see patients at our office ( not located on the hospital campus) for office visits and labs. My question is this, The provider team wants to rotate through the offsite infusion center which is on the Hospital Campus and want to see patients for office visits. Is that even possible? if so we would bill the appropriate level of service with a POS of 22 not 11.

 

[thomas7331]

Yes, as long as your providers have hospital privileges and the hospital has allocated the space and staff needed to do this, they may evaluate patients there and the practice may bill for their professional services. For patients who are not inpatient or observation status, your E&M levels would be the same as for the office. POS 22 is correct for on-campus hospital. Your reimbursement under POS 22 will be lower than in POS 11 for most payers because the hospital will be billing for their own expenses and the use of their space and auxiliary personnel. Because of this, you may wish to set your fees lower in that place of service accordingly.