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Billing for a patient seen a senior living facility

Suhel Posted Mon 05th of December, 2011 21:51:07 PM

Would the place of service be # 13? Then i would have to put the name and address of the facility in box # 32 of the CMS claim form. But this facility does not have a NPI #. Will Medicare accept a claim without the NPI #?

SuperCoder Answered Tue 06th of December, 2011 06:45:45 AM

POS #13 is for Assited Living Facility and it would be for Senior Living Facility because senior living facility providing services in a 24-hour residential setting for persons of appropriate level of care needs, included within the levels of care are assisted living accommodations.
Medicare will not accept the claim without the NPI #.
For your reference:
http://www.wpsmedicare.com/j5macpartb/resources/new_providers/providernumber.shtml

https://www.cms.gov/MLNMattersArticles/downloads/MM5595.pdf

Suhel Posted Tue 13th of December, 2011 16:31:46 PM

SO HOW SHOULD I BILL FOR THIS PATIENT? WHAT SHOULD I PUT IN BOX #32?
PLEASE ADVISE. THANKS

SuperCoder Answered Wed 14th of December, 2011 07:12:12 AM

On Box #32, actually you should fill up Service Facility Location Information. This field is required only if the POS on any service line equals 21, 22, 23, 31, 32, 51 or 54. Enter the service facility name and address. The service facility can also be entered even if it is not required.

On Box #32a, the service facility’s NPI is required if the POS on any service line equals 21, 22, 23, 31, 32, 51 or 54.

So here your POS is falling #13. Therefore, NPI is not essential to put because if POS is from #21-54, NPI is mandatory. Here simply you can put Facility name and address in Box #32. For NPI, the provider who actually provided services for this, by his/ner personal NPI, you could put in Box #33a and you can submit the claim.

Suhel Posted Fri 16th of December, 2011 18:44:53 PM

Thanks for your help, Birendra.

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