TOB code for Medicare Advantage

[homehealthbiller]

Does anyone have an advise on which TOB code to use for Private Duty Nursing (hourly) for a Medicare Advantage claim?

The client has been receiving Private Duty Nursing 24 hours per day x 7 days per week since 1/1/12.

My claim defaulted to TOB 333 and the claim was denied for using the wrong TOB. 

Also, the insurance stated the UB04 showed place of service as Outpatient.  Can someone direct me to which field on the UB 04 this refers to as I am pretty use we were using code 12 (Home).

[homehealthbiller]

I forgot to mention that we are a home health agency, but we are not billing this through our Home Health Divsion.  We were told by the insurance we do not need to bill Medicare first for the denial since Private Duty Nursing is not covered under Medicare.

[Michele]

The type of bill isn't determined by what you are billing.  It is determined by the provider/facility/agency that is billing for the services.  So even if it's not considered HH and private duty isn't covered, if the HHA is the one billing for the private duty the type of bill would indicate HHA.

Hope that helps.

[homehealthbiller]

So, if they are telling me I am billing as an outpatient facility, rather than a HHA, it's because I am using 333 for the TOB?
Any idea what the correct TOB would be?

[Michele]

Maybe you could try 223.  The initial 2 is for "Skilled Nursing".

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