sjstark
New
I have a question regarding place of service (POS) usage. We have a Podiatry facility we will bill for in NY. The facility will bill the facility claims for Medicare, Medicaid, and Medicaid Managed Care plans using a POS 22 (outpatient). We will bill for the professional claims using POS 22 as well. These claims are for E/M and procedural services. The question comes in when billing for commercial insurance plans which will only be billed under the professional claim. If we bill with a POS 22 for these insurance plans we will receive a reduced reimbursement if compared to the same services paid in an office setting. In turn, the facility will lose out on reimbursement because the facility will not bill for a portion of these claims.
It was suggested that we bill using a POS 11 (office) for all the commercial claims and use POS 22 for Medicaid, Medicare, and Medicaid Managed Care. Billing in this manner would get the commercial claims reimbursed the maximum allowed and the governmental claims for the correct professional portion only. Would it be appropriate to bill different place of service codes based on insurance plan? Any input would be greatly appreciated.
Thanks, Scott
It was suggested that we bill using a POS 11 (office) for all the commercial claims and use POS 22 for Medicaid, Medicare, and Medicaid Managed Care. Billing in this manner would get the commercial claims reimbursed the maximum allowed and the governmental claims for the correct professional portion only. Would it be appropriate to bill different place of service codes based on insurance plan? Any input would be greatly appreciated.
Thanks, Scott