Medical Billing Forum
Billing => Billing => : Christy February 01, 2015, 03:39:38 PM
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A nutritionist travels to an assisted living and sees a patient with a service that is completely payable in the office (POS 11.)
The assisted living DOES NOT have an NPI #.
What POS should be billed for Medicare? Home or assisted living?
Yes, it's an assisted living, but with no NPI, what would go in box 32A?
thanks!
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Doesn't the nutritionist have to have an NPI to bill at all?
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We have a Physician's Assistant who does work at patients homes. We place the PA's NPI number in 24J and the patient's home address in Box 32 - since that was where the service was delivered. There is no NPI Number assigned to the patien'ts home address, so we put nothing there. We get paid from Medicare just fine.
An assisted living facility is the patient's home when you include the patient's room number in the address block (although you need to use the POS for assisted living). I think you don't need an NPI Number for this.
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yes, the nutritionist has an NPI and is registered with Medicare at her office address....
very interesting, Richard. Thank you!!!
I have another question: for Medicare, home visits need to be recommended by the PCP, correct? Is this some formal process with Medicare, or is a written request from the PCP to the specialist ok?
thanks again!
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yes, the nutritionist has an NPI and is registered with Medicare at her office address....
Ok, so wouldn't you use POS 13 and her NPI?
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POS 13, her NPI in Box 24J, and nothing in Box 33a.
I know that this works when POS is 12. I have no experience with POS 13. But an assisted living facility is "home" for the folks who live there. Which raises the question of whether one could get away with using POS 12 if they include the patient's room number in the address at Box 33.
Edit: I just re-read the discription of POS 12: Location, other than a hospital or other facility, where the patient receives care in a private residence. That description doesn't fit this situation.
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Are you talking about a dietician? Medicare only covers for certain diagnosis. If the patient is in an assisted living facility who is the medical provider (dietician) counselling? In this scenario doesn't the facility supply the food?
Merry
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yes, a dietician. Yes Medicare covers with a dx of diabetes or chronic renal failure. The dx is payable. The provider billed some claims as POS 11 when they were actually provided at the assisted living. They all came back paid, except this one, which was denied for invalid POS. The claim was pended for a very long time. Is it possible that the patient was questioned by Medicare re: where the svcs were rendered? He is legally blind.
I am trying to help her do this correctly going forward. The CPTs 97802 and 97803 are allowed at POS 11, 12, 13.
But is there some sort of permission needed from Medicare for the nutritionist to travel to the assisted living and see people? This happened before I came on board, but I think that one of the administrators at the assisted living just called her (the provider) up and lined up patients for her, ugh.
Merry- VERY interesting point about the assisted living providing food. The provider did mention that there is a place next door that sells ice cream, junk food etc. and the residents walk over there and buy it, lol!
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