Richard Posted Mon 28th of January, 2019 14:03:42 PM
I provide medical eye care at Independent Senior Living Facilities (not nursing homes or assisted living facilities). These independent senior living facilities do not have an NPI. My services are performed in an enclosed area or office space. My equipment is portable.
For CMS 1500 Medicare billing purposes, can you advise the appropriate (1) Place of Service (box 24-B), (2) Service Facility Location (box 32), and (3) Required Service Facility Location NPI (box 32-A) for independent senior living facilities?
The Medicare Enrollment Application states: "Physicians and non-physician practitioners (e.g., nurse practitioners, physician assistants) who perform services at multiple locations (e.g., house calls, assisted living facilities) are not considered to be mobile facilities / portable units." Therefore, I can't use POS #15 for box 24-B.
I'm having difficulty finding a clear answer, so I would be grateful for any help you can provide!
SuperCoder Answered Tue 29th of January, 2019 07:56:56 AM
Thanks for your question. Please find your answer below:
- Since you provide your services to your patients at different places, you should use the particular POS code depending upon the place where the services have been provided. Now the Independent Senior Living Facility is one of those places but there is no POS for Independent Senior Living Facilities. For this, you may use POS #99 (Other place of service not identified above) in box 24-B.
- As per CMS, “Item 20 - Complete this item when billing for diagnostic tests subject to the anti-markup payment limitation. Enter the acquisition price under charges if the "yes" block is checked. A "yes" check indicates that an entity other than the entity billing for the service performed the diagnostic test. A "no" check indicates "no anti-markup tests are included on the claim." When "yes" is annotated, item 32 shall be completed…” This means in box 20, if “No” is checked, then box 32 (or 32a) should NOT be filled.
Please feel free to write if you have any question.
Richard Posted Tue 29th of January, 2019 11:58:44 AM
1. So you suggest that I use "99" for box 24-B as well as "No" for box 20 and not list any charges in box 20 as the best option as opposed to using POS #12 (i.e. "Home: location, other than a hospital or other facility, where the patient receives care in a private residence"? 2. Since I am performing these services in an private space in a facility associated with their private residence, am I able to use POS #12? If yes, will Medicare require an NPI number with the service location address?
SuperCoder Answered Wed 30th of January, 2019 09:34:06 AM
Thanks for your comment.
POS 99 should be used when a particular place of service is not there in the list of POS and POS 12 should be used when the services have been provided at home/private residence. If services are performed in a private space/private residence, then POS #12 may be used in box 24-B.
Box 20 is for purchased diagnostic tests from outside lab, which is not the case here. So, you should check "No" in box 20 and there is no need to fill box 32.
Hope this answers your question. Please feel free to write if you have further concern.