2. AGENDA
❏ POS and it’s definition
❏ Types of POS with explanation
❏ Capturing POS
❏ Common errors we do
❏ Consequences of wrong POS
❏ Conclusion
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3. Objective
◈ Ensure proper place of service code selection
◈ Support rationale and detailed information on POS codes.
◈ Understand the list and definition of common POS codes
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5. Definition!
The location where health services and health
related services are provided or received,
through telecommunication technology
◈ A two-digit code used on health care
professional claims to indicate the setting
in which a service was provided.
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6. 1. Where do the Place of Service codes come
from?
The Place of Service codes can be found on the CMS website and contains
two-digit codes placed on health care professional claims to indicate the
setting in which a service was provided. The Centers for Medicare &
Medicaid Services (CMS) maintains POS codes used throughout the
healthcare industry.
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7. 2. Why are place of service codes important?
● POS information is often needed to determine the acceptability of direct billing of
Medicare, Medicaid and private insurance services provided by a given provider.
● Place of service code helps the insurer to ascertain the place where the
medical facility was rendered. ...
● Matching of the current location of service codes to the procedural codes is
crucial while reimbursing the claims.
● If the place of service code does not correlate with treatment code, the
claim may get denied.
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8. “
How is place of service
determined?
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• According to the Medicare Claims Processing Manual, chapter 26, section
10.5, the POS is determined based on the patient's registration status
at the time that the physician sees the patient. ...
• When a physician/practitioner furnishes services to a registered inpatient,
payment is made under the PFS at the facility rate
10. 0 NOT SUPPLIED
01 PHARMACY
03 SCHOOL
04 HOMELESS SHELTER
05 INDIAN HEALTH SERVICE FREE-STANDING
FACILITY
06 INDIAN HEALTH SERVICE PROVIDER-BASED
FACILITY
07 TRIBAL 638 FREE-STANDING FACILITY
08 TRIBAL 638 PROVIDER-BASED FACILITY
11 OFFICE
12 HOME
13 ASSISTED LIVING FACILITY
PLACE OF SERVICE CODES
14 GROUP HOME
15 MOBILE UNIT
20 URGENT CARE FACILITY
21 INPATIENT HOSPITAL
22 OUTPATIENT HOSPITAL
23 EMERGENCY ROOM – HOSPITAL 24
AMBULATORY SURGICAL CENTER
25 BIRTHING CENTER
26 MILITARY TREATMENT FACILITY
31 SKILLED NURSING FACILITY
32 NURSING FACILITY
33 CUSTODIAL CARE FACILITY
34 HOSPICE
10
11. • 41 AMBULANCE (LAND)
42 AMBULANCE (AIR OR WATER)
49 INDEPENDENT CLINIC
50 FEDERALLY QUALIFIED HEALTH CENTER
51 INPATIENT PSYCHIATRIC FACILITY
52 PSYCHIATRIC FACILITY, PARTIAL
HOSPITALIZATION
53 COMMUNITY MENTAL HEALTH CENTER
54 INTERMEDIATE CARE FACILITY/MENTALLY
RETARDED
55 RESIDENTIAL SUBSTANCE ABUSE TREATMENT
FACILITY
56 PSYCHIATRIC RESIDENTIAL TREATMENT
CENTER
PLACE OF SERVICE CODES
57 NON-RESIDENTIAL SUBSTANCE ABUSE
TREATMENT FACILITY
60 MASS IMMUNIZATION CENTER
61 COMPREHENSIVE INPATIENT REHABILITATION
FACILITY
62 COMPREHENSIVE OUTPATIENT
REHABILITATION FACILITY
65 END STAGE RENAL DISEASE TREATMENT
FACILITY
71 STATE OR LOCAL PUBLIC HEALTH CLINIC
72 RURAL HEALTH CLINIC
81 INDEPENDENT LABORATORY
99 OTHER UNLISTED FACILITY
11
12. 12
01 Pharmacy ** A facility or location where
drugs and other medically related items and services
are sold, dispensed, or otherwise provided directly to
patients. (Effective October 1, 2003)
02 Telehealth
The location where health services and
health related services are provided or received,
through a telecommunication system. (Effective
January 1, 2017)
TYPES OF POS
13. TYPES OF POS
3 School A facility whose primary purpose is education. (Effective
January 1, 2003)
13
11 Office Location, other than a hospital, skilled nursing
facility (SNF), military treatment facility, community health
center, State or local public health clinic, or intermediate care
facility (ICF), where the health professional routinely provides
health examinations, diagnosis, and treatment of illness or injury
on an ambulatory basis.
14. TYPES OF POS
12 Home Location, other than a hospital or other facility, where the patient
receives care in a private residence. This is a location other than facility or
hospital where the patient receives care.
14
15 Mobile Unit
A facility/unit that moves from
place-to-place equipped to provide
preventive, screening, diagnostic, and/or
treatment services.
15. Place of Service Code(s) Place of Service Name
Place of Service Description
19 Off Campus-Outpatient Hospital
A portion of an off-campus hospital provider based department which
provides diagnostic, therapeutic (both surgical and nonsurgical), and
rehabilitation services to sick or injured persons who do not require
hospitalization or institutionalization.
15
22 On Campus-Outpatient Hospital
A portion of a hospital’s main campus which provides diagnostic,
therapeutic (both surgical and nonsurgical), and rehabilitation
services to sick or injured persons who do not require hospitalization
or institutionalization. (Description change effective January 1,
2016)
16. Place of Service Code(s) Place of Service Name
Place of Service Description
20 Urgent Care
Facility Location, distinct from a hospital emergency room, an
office, or a clinic, whose purpose is to diagnose and treat illness or
injury for unscheduled, ambulatory patients seeking immediate
medical attention. (Effective January 1, 2003)
16
21 Inpatient Hospital
A facility, other than psychiatric, which primarily provides
diagnostic, therapeutic (both surgical and nonsurgical), and
rehabilitation services by, or under, the supervision of
physicians to patients admitted for a variety of medical
conditions.
17. Place of Service Code(s) Place of Service Name
Place of Service Description
17
23 Emergency Room – Hospital A portion of a hospital
where emergency diagnosis and treatment of illness or injury
is provided.
24 Ambulatory Surgical Center A freestanding
facility, other than a physician’s office, where surgical
and diagnostic services are provided on an ambulatory
basis.
18. Place of Service Code(s) Place of Service Name
Place of Service Description
18
25 Birthing Center
A facility, other than a hospital’s maternity facilities or a
physician’s office, which provides a setting for labor, delivery,
and immediate postpartum care as well as immediate care of
newborn infants.
31 Skilled Nursing Facility
A facility which primarily provides inpatient skilled
nursing care and related services to patients who require
medical, nursing, or rehabilitative services but does not
provide the level of care or treatment available in a
hospital.
19. Place of Service Code(s) Place of Service Name Place
of Service Description
34 Hospice A facility, other than a patient’s home, in
which palliative and supportive care for terminally ill
patients and their families are provided.
41 Ambulance – Land A land vehicle specifically designed,
equipped and staffed for lifesaving and transporting the sick or
injured.
42 Ambulance – Air or Water An air or water vehicle
specifically designed, equipped and staffed for lifesaving and
transporting the sick or injured.
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20. Place of Service Code(s) Place of Service Name
Place of Service Description
51 Inpatient Psychiatric Facility
A facility that provides inpatient psychiatric services for the
diagnosis and treatment of mental illness on a 24-hour basis, by
or under the supervision of a physician.
52 Psychiatric Facility-Partial Hospitalization
A facility for the diagnosis and treatment of mental illness that
provides a planned therapeutic program for patients who do not
require full time hospitalization, but who need broader programs
than are possible from outpatient visits to a hospital-based or
hospital-affiliated facility.
20
21. Place of Service Code(s) Place of Service Name
Place of Service Description
71 Public Health Clinic A facility maintained by either State
or local health departments that provides ambulatory primary
medical care under the general direction of a physician.
21
72 Rural Health Clinic A certified facility which is
located in a rural medically underserved area that provides
ambulatory primary medical care under the general
direction of a physician.
23. Understanding How Place of Service Codes Work
❏ Type of service (TOS) codes are used on hospital and facility claims, also indicating the place of service
along with additional information reported on a UB-04.
❏ Different sites may pay a different rate if the services are provided in a facility versus a non-facility
setting. This is called a payment differential.
❏ When billing the professional component (PC), the rates are the same and do not depend on the clam's
POS code.
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24. Telehealth POS Code Changes
• POS 02 has been changed to reflect patients who receive
telehealth in locations other than their home, and POS 10
has been added to reflect patients who receive telehealth in
their home. The following are the new descriptions for each
code:
∙ POS 02: Telehealth Provided Other than
in Patient’s Home –
∙
∙ POS 10: Telehealth Provided in Patient’s
Home –
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25. •Telehealth POS Codes for Medicare
25
So how do you indicate POS when billing telehealth to Medicare?
•For dates of service March 1, 2020, through the end of the COVID-19 Public Health Emergency (PHE), the following
guidelines have been established for indicating place of service when billing telehealth to Medicare:
❏ Place of Service (POS) equal to what it would have been had the service been provided in-person
❏ Modifier 95, indicating that you provided the service via telehealth
26. Important facts when filing a claim to Medicare
The name,
address and ZIP
code - Item 32
POS - Item 24 B
Components
of the MPFS
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27. Important facts when filing a claim to
Medicare
•POS 22 On Campus-Outpatient Hospital
•POS 19 Off Campus-Outpatient Hospital
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28. There are two exceptions to this face-to-face provision/rule
The correct POS code assignment is for
that setting in which the beneficiary is
receiving inpatient or outpatient care
from a hospital, including the inpatient
hospital (POS code 21) or the
outpatient hospital (POS code 22)
Place of Service (POS)
Invalid
If place of service is invalid,
must support validity of the
place of service coding. If place
of service code not valid, claim
will be returned as
unprocessable
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29. Cue’s for capturing POS codes
Implement internal
control systems to
prevent incorrect billing
of POS codes
Keep informed on
Medicare coverage
and billing
requirements
For example, billing physician’s
office (POS 11) for a minor surgical
procedure that is actually
performed in a hospital outpatient
department (POS 22) and collecting
a higher payment is inappropriate
billing and may be viewed as
program abuse
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31. 31
Common Errors
❏ Insufficient documentation
❏ Medical Record Documentation and/or physician signature was missing or
was not legible
❏ Medical record did not contain a valid physician’s order, documented order
intent or clinical indication for the service
❏ Medical necessity errors
❏ Medical record lacked sufficient documentation to support the medical
necessity of the procedure/service performed
32. 32
CAUSES OF OVERPAYMENTS
* Billing personnel were confused about the precise definition of a “physician’s office” or other non facility
location or were simply following established practices in applying the non facility codes.
* Incorrect place-of-service code could result in an increased Medicare payment.
* Billing personnel made isolated data entry errors.
* Undetected flaws in the design or implementation of some billing systems caused all claims to be submitted
with a non facility location as the place of service.
34. How does an incorrect place of service codes in
medical billing affect your practice?
★ Impact on reimbursement
★ Adds to more administrative time
★ May cause complaints against you: An incorrect code may lead to legal implications.
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35. PAYMENTS FOR INCORRECT PLACE-OF-SERVICE
CODES
•Physicians did not always correctly code non facility places of service on
Part B physician claims submitted to, and paid by, Medicare contractors from
January 2010 through September 2012.
• As a result, Medicare contractors potentially overpaid physicians
approximately $33.4 million for physician services provided in facility
locations.
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36. PAYMENTS FOR INCORRECT PLACE-OF-SERVICE
CODES
•Billing staff is aware that the POS code can affect Medicare payment and
that inaccurate use of non-facility POS codes can mean potential Medicare
overpayments.
•Billing systems are not designed to submit all physician professional
service claims with a non-facility POS code
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37. 37
What are potential penalties that can be incurred by
not returning overpayments?
Failure to comply with the law and regulations related
to overpayment returns can lead to the imposition of
civil monetary penalties, potential exclusion from
federal healthcare programs, and possible False
Claims Act litigation.
39. 39
POS plays a major role for the people (e.g. Tribals) to render the service
with low or Free of cost.
Every “POS” codes has professional payment amount, which helps the
insurance company to claim appropriately and provide more coverage.
Claims are processed based on Revenue codes (it is derived based on the
where (POS-) and when they receive treatment).
