j.monday7814
Guest
I need help regarding final claim submission to Medicare for professional services to a patient admitted to SNF.
I have searched as much as I can and I cannot find any definitive information regarding correct billing. Our original claims were submitted with POS 11 and at first they were paid. Then a few months later Medicare recouped the payment stating the patient was enrolled in SNF. So, I need answers with supporting guidelines from any payer (preferably Noridian or CMS) please.
typical scenario: patient is enrolled in SNF (as inpatient) and comes to our office to see the physician (typically a specialist, i.e. cardio, general surgery, vascular, etc.). We bill Medicare with POS 11 (office, because that is where the patient was seen).
We're stuck on the POS because about a year ago another coder in the office researched this issue and created a policy to change the POS to 31 (SNF because that is where they are currently admitted). The E/M is also changed to a corresponding inpatient code. I feel very uncomfortable billing these out, I can't justify billing an incorrect POS. This new policy does allow claims to be paid but I still don't think it is appropriate billing. Please help us sort this out.
I have searched as much as I can and I cannot find any definitive information regarding correct billing. Our original claims were submitted with POS 11 and at first they were paid. Then a few months later Medicare recouped the payment stating the patient was enrolled in SNF. So, I need answers with supporting guidelines from any payer (preferably Noridian or CMS) please.
typical scenario: patient is enrolled in SNF (as inpatient) and comes to our office to see the physician (typically a specialist, i.e. cardio, general surgery, vascular, etc.). We bill Medicare with POS 11 (office, because that is where the patient was seen).
We're stuck on the POS because about a year ago another coder in the office researched this issue and created a policy to change the POS to 31 (SNF because that is where they are currently admitted). The E/M is also changed to a corresponding inpatient code. I feel very uncomfortable billing these out, I can't justify billing an incorrect POS. This new policy does allow claims to be paid but I still don't think it is appropriate billing. Please help us sort this out.