Author Topic: Place of Service dilemma  (Read 1158 times)

kristin

  • Sr. Member
  • ****
  • Posts: 489
Place of Service dilemma
« on: March 01, 2016, 08:32:18 PM »
Hi, I am having a dilemma about what POS to use for a situation I have never encountered before. Between me, the provider, and the owner of the billing company I work for, we have come up with three different options, and I don't know that any of them are correct, so I was hoping for some input from someone else, who has more knowledge about this type of situation.

The scenario is the provider will begin seeing residents in a senior living apartment building, that has no medical component. The director of the building is renting out the use of an office once a week to the provider. There is no NPI associated with the building, as there is no medical component there, as I mentioned before. The POS that are being considered are 11, 13, and 33.

I just don't know which POS is most accurate. I am leaning towards 11, since he is paying rent, and is "routinely" seeing patients there once a week, which is necessary for POS 11. And the only NPI we have for service location is his NPI, since the place doesn't have one. Yet, that somehow doesn't seem quite right to me. If he was seeing them in their individual apartments, I would use POS 12, but he isn't, so that won't work.

Any ideas/thoughts? TIA!

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4706
    • Solutions Medical Billing
Re: Place of Service dilemma
« Reply #1 on: March 02, 2016, 11:53:56 AM »
Is it an assisted living facility or simply an apartment building for older people?  Sounds like an apartment building for older people.  So you are write in thinking that if he went into their apartments it would be a 12.  The 13 would only be if it were an assisted living facility.  The 33 would not be correct.  In any situation you would not need the building to have an NPI, you will be using the provider's NPI.  If he is set up with insurance carriers he should notify them that he has another office location.  He will just use the NPIs that he already has.  Since he is renting space he can call it an office.  Is the space used solely for him?  That may be the only issue. 
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

kristin

  • Sr. Member
  • ****
  • Posts: 489
Re: Place of Service dilemma
« Reply #2 on: March 02, 2016, 12:11:50 PM »
Hi Michele-

It is an apartment building with some common areas/offices. The "office" he is renting is also used as a Wellness office, where I guess residents can go and talk to someone about fitness, diet, etc. He has notified Medicare, CAQH, etc, that this is a new service location for him. My biggest issue is what you mention, that it isn't just HIS office, it is used for other things, he just pays rent to use it once a week for four hours. So I just don't know if 11 will work or not.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4706
    • Solutions Medical Billing
Re: Place of Service dilemma
« Reply #3 on: March 03, 2016, 07:06:39 AM »
I believe it will however I know there are some 'rules'.  I would contact Medicare provider enrollment and explain it to them to ask if that would qualify as an office.  I believe it does but I think there are some rules such as his name may have to be posted outside.  I know I looked into this once a couple of years ago for a dr that was working at a nursing home but he wasn't going to the patient's rooms, they were coming to him in one room.  I believe Medicare gave me the guidelines as to how to determine if it's an office.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

kristin

  • Sr. Member
  • ****
  • Posts: 489
Re: Place of Service dilemma
« Reply #4 on: March 03, 2016, 08:20:56 PM »
Thanks for all your help Michele, I will have them call Medicare!