I did come across a topic on this site where it seems that at least for Medicare (& other insurances too?) I have to be able to provide proof of medical necessity. What if there isn't medical necessity but the physician is just a nice guy who doesn't mind doing house calls? Or it's a way to obtain a larger patient base? Is it not worth it then? Would we not get paid for the house calls? Should they be billed as regular office visits in that case, or is that dishonest?
It seems, after some research, that the only differences between billing for an office visit and a home care visit are the POS (21 instead of 11), and the visit codes (99341-99350). Does anyone know of anything else I need to be doing?
You can find the definition of POS 11--Office--on the CMS website:Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.Depending on your provider type, he/she may routinely provide care outside of a typical office setting and still be able to bill it as POS 11. We bill for midwives who do most of their work at home. Some have offices, some have a home office and some simply drive from one client's home to another client's home. We bill this care with POS 11. I have checked with several CPCs and insurance carriers and this has been determined not to be fraud, since this is where the provider routinely provides care.I agree with what has already been said here about contacting your doc's carriers and finding out what their requirements are regarding home visits (POS 12), especially if he/she is contracted.~Kelli