Place of Service incorrectly billed (22 versus 24)

[prasi]

Hello All,
Looking for a little insight and help here for our Orthopedic Practice. Unfortunately, it's been recently discovered that our RCM has billed all of our professional services performed at an ASC (24) as POS Outpatient Hospital (22). We will need to send more than 100 corrected claims and are of course concerned with reimbursement changes. Can anyone shed light on what we may expect as far as claims reprocessing from POS 22 to 24 and what our reimbursement may look like? Our billing is primarily total knee replacements and revisions. Thank you in advance for any advise here...

 

[thomas7331]

There should be no difference in reimbursement between place of service codes 22 and 24 for professional services - these are both paid at the facility rate. I have never encountered a payer that would calculate the reimbursement differently between these two locations, though you would need to look at your contracts and check with your payers to know this for sure. In my opinion, with no effect on reimbursement, and as long as the facility where the service was performed was identified correctly on the claim in box 32, just my opinion, but I believe that payers would not want you to submit corrected claims to make a minor change such as this as the cost would exceed any benefit from doing so.

 

[prasi]

Thank you very much for the insight...and peace of mind you've offered! Much appreciated.