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Facility billing of emergency/observation billing with POS 23

B

Bluteam

Guest
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6
Location
Grand Rapids, MI
Hello, when the facility has a patient that comes in thru ER and then has to be placed into observation the POS is coming over into our system as a 22 claims are denied for Authorization NOT Matching what the facility billed. The facility never gets an authorization as Emergency and Observation are both an exclusion... what is the appropriate action change the POS to 23 and add ET modifier for the BCBS plans, we bill for Reading the radiology and Interventional services mod 26 is billed on 1500 the auditor of our company stated that this is an incorrect action...... CMS states if there is contradiction between the facility and professional POS you are to follow what the facility bills does anybody know? Need assistance
 
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