Pos guidelines

herrera4

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I work at an LTACh facility that bills Inpatient and Outpatient services.

my question is-if a patient is here for Inpatient admission, we bill POS 21. If he leaves our facility to go to Dr.s office (different Tax ID POS 11) for services we can not provide. How does the Dr.s bill Medicare to receive payment and not denied as POS invalid. Im reading an MLN Matters # MM7631, and I am getting that POS should be billed as POS 21 as well. even if services were in office location. Under CR7631 tere is a section SPECIAL CONSIDERATIONS FOR SERVICES FURNISHED TO REGISTERED INPATIENTS.

Could someone please verify if im reading correctly, or explain if im not? thank you
 

mitchellde

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Yes that is correct. The premise being that a patient can be registered as a patient in only one location at a time. SO if they are still registered as an inpatient, then no matter what service or where they are still an inpatient and cannot also be an office patient or an outpatient.
In addition the provider can leave the office and travel to the hospital to provide the same service in house. So when the patient is traveled to the office, it is less of an inconvenience to the provide, yet Medicare is paying the overhead for that day to the facility and they are not going to pay the technical portion also to the provider, so the provider is reimbursed the same as if they saw the patient in the facility, which is a lesser amount than if it were POS 11.
 

herrera4

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Thank you Debra! I really appreciate you confirming-it didn't seem right , for whatever reason to me
 

lburns23

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I am having this similar issue, from the other perspective. We had a patient come to our office for an EMG, but she was inpatient rehab at the time. This is a new scenario for our clinic, and I was told by the hospital that we should bill *them* for the EMG but *Medicare* for the E&M. I know to use POS 21, but I am confused as to whether to bill our location as the service location (which is accurate, but we are POS 11 and not 21) or use the hospital's physical location (which is POS 21 but not where the services were actually provided). Do you have any insight on this? Sorry to piggyback on your post but I think it's very relevant to your own question. Thanks!
 
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