Healthcare providers must be familiar with medical billing procedures by using proper codes to receive appropriate reimbursement for their services and selling medically related items to a patient. Knowing the professional billing process is essential for submitting claims by using the CMS-1500, the professional paper claim form. The form is applicable for non-institutional suppliers or providers to raise bills on Medicare and DMERCs (durable medical equipment regional carriers) if the provider qualifies for a waiver from electronic submission of claims. In medical billing, POS 11 and POS 22 are the Place of Service codes. These codes refer to the physical location where medical service and supplies are provided to a patient. Keep reading to know more about Place of Service 22 and Place of Service 11 codes and their importance for medical billing.
What is a Place of Service 22 code?
To ensure higher reimbursement rates by reducing the denial rate, it is essential to use the right Place of Service or POS codes. The Place of Service or the location where the patient receives the service is a critical parameter for medical billers. And they must mention it correctly by using the proper code. Each Place of Service, such as a hospital, doctor’s office, patient’s home, or clinic, is a unique location defined by specific codes to differentiate between them. POS 22 in medical billing specifies where patients received services and supplies during treatment. Besides identifying the type of location, the codes help to specify the related costs and reimbursement rates. POS 22 code not only refers to the location of providing medical services but also signifies that the services were offered in an ‘Outpatient hospital setting’ without admitting the patient.
POS 22 code is applicable when medical services include various hospital resources. The resources include outpatient surgeries or diagnostic tests. The patient need not spend the night at the hospital. As hospital resources are expensive, the POS 22 code relates to higher reimbursement rates than other POS codes.
More on It
POS 11 and POS 22 codes are similar because both refer to the location of medical services. However, POS 11 in medical billing means explicitly that the location was not a hospital but an office. It could be a clinic, physician’s office, or any other facility equivalent to an office. For example, consultations, routine checkups, and other medical services provided in an office would call for a POS 11 code when billing. Using the correct POS code for each service is crucial for ensuring correct reimbursement for the costs mentioned in the bill.
The accuracy of the POS 11 code is essential for claiming the appropriate costs of medical services. The services are provided and receive the same while reducing the chances of denial of the claim. Using proper POS codes is necessary for complying with the billing guidelines and eliminates the chances of delayed payments, claim denial, and even allegations of abuse or fraud.
Codes are Beneficial for Payers too
Medicaid, CMS, and other private insurers find the billing codes extremely useful to ascertain the justification of claims, pay the most justified amount, and gather extensive data to understand trends. Analysis of POS 11 data helps healthcare organizations and payers understand utilization patterns and trends. The same is true for the POS 22 code.
By analyzing the Place of Service 22 code, payers can gather helpful information about the types of services and the frequency of medical services available in an outpatient hospital setting. Reports generated by analyzing the data related to the POS 22 code provide valuable insights useful for quality improvement initiatives and cost savings. CMS, or the Centers for Medicare & Medicaid Services, maintains POS codes applicable across the healthcare industry. To process the claims, CMS requires the physician’s address, zip code, and location mentioned in the CMS-1500 form. POS codes are essential for specifying the location, whether it’s an outpatient hospital setting or an office setting.