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Pos- asst living "clinic"

  1. Default Pos- asst living "clinic"
    Medical Coding Books
    I have a physician that has "clinic" once a month at an assisted living facility. We bill new and est office visits. Medicare has not paid any of our claims stating "invalid pos". What is the correct pos i should be using?

  2. Default
    Are you using 13 for assisted living facility?

  3. Default
    Yes, I did. Is that what I should be using? If so, I think it is set-up incorrectly in our system.

  4. #4
    Dover Seacoast New Hampshire
    You sometimes have to think like Medicare. (what an awful thought!) In your case, the CPT code is not the correct code for the POS. For POS 13, you must use the CPT codes from 99324-99337. The office visit codes (99201-99215) will surely deny without POS 11. Pam Brooks, PCS, CPC

  5. Default
    Ohhhhh. Thanks sooo much, DUH!! So, Medicare was telling me that the POS was invalid. They meant for the codes I was billing with that POS, not invalid to them entirely?!? Also, should my physician have a separate location ID for the facility? Or just bill as usual with the correct codes and POS 13?

  6. #6
    Dover Seacoast New Hampshire
    Nope the Payer ID is by provider, not by facility. You should be all set. Pam

  7. #7
    Default assisted living
    I am also having problems getting our assisted living visits paid and hope maybe someone can help me. We are using the correct pos but my denials are because I do not have an NPI for the assisted living center, our physician goes to two different ones and I have called them both and they both tell me they dont need an NPI number and they do not have one. I am sure they are mistaken snd I have tried looking them up on the NPI search and cannot find either of them. Has anyone ever heard of this and if this is correct, how are you getting your claims paid by Medicare?

  8. #8
    Dover Seacoast New Hampshire
    They're not mistaken. You don't need an NPI number for assisted living facilities, because they do not (by definition) have a medical component.

    We contacted Medicare, (for us, it's NHIC), and they did confirm this.
    I'd try calling your Medicare rep. personally to see if your local carrier has different guidelines.

  9. #9
    So how are you getting your claims paid? Since this is the patients home can I just use location 12 for home? I did find out later in the day that they don't bill Medicare so they actually don't have an NPI just like you said, that surprises me. Anyway thanks for your info and maybe I can just bill location 12

  10. #10
    Dover Seacoast New Hampshire
    Assisted Living facilities are POS 33.

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