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place of service 21 defintion per medicare

  1. #1
    Default place of service 21 defintion per medicare
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    can someone clarify billing pos 21 per medicare - is it based on how long the patient is in the hospital over 24 hours? or something different- I always knew if a patient is admitted, it would be considered inpatient (21) but I am hearing the medicare says inpatient has to be 2 midnights that he patient is in the hospital.

    Please advise...........thanks!

  2. #2
    I found this out on the web:

    As part of the rule, the CMS attempted to clarify observation and short-stay criteria and give physicians and hospitals guidance as to which patients should be admitted. This is the first regulation that Medicare has issued to address the definition of “inpatient.” Prior to this rule, the CMS had issued only guidance for defining an inpatient status.

    The new standard was also intended to address concerns that some Medicare patients have inappropriately long observation stays, which is considered outpatient status. These extended outpatient stays have been a sticking point for patients who incur higher out-of-pocket expenses due to non-covered services, higher deductibles and denied coverage for services in skilled nursing facilities.

    The new rule states that in deciding whether patients should be admitted, physicians should reasonably expect that a patient’s stay will span two continuous midnights. If doctors don’t have this expectation, according to the new rule, patients should instead be in observation or other outpatient status.

    Medicare guidelines say they should CONSIDER admitting a patient if they know the patient care is going to require more than a two day stay but they do not HAVE to if they do not know how long the patient care is going to take.

    We can only bill with the information we are given so I use whatever status the hospital states no matter how long the patient stay is.

    Hope it helps!
    Carol Gaston CPC CRC CPCO

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