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POS issue

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Neuro13:
Is it common for a POS to work with Medicaid and not with Medicare?

In my situation I bill CPT 95951 TC with (12) the patients home.  Medicare rejects the claim due to improper place of service, yet Medicaid pays out in this situation.  The professional and global codes are both acceptable with Medicare in the patients home.  It seem that only the technical component is denied.

My whole business is built around providing the patient with convenient in home care.  I'm wondering if this is an error .. Any ideas?

Michele:
We have come across a similar situation with a different code.  Our dr goes into the nursing home to see patients.  He brings in the machine and does global services for the procedure but he can only bill Medicare for the PC with the POS 31.  However, Medicaid pays for both TC & PC so we bill them global.  We have talked to Medicare about it but they say there is nothing we can do.  That is just their policy.  I'm going to assume it's the same.  So in answer to your question, Yes, it is common for a POS to work with Medicaid but not Medicare. :(

Neuro13:
Any chance you tried going through this process? 

http://www.cms.gov/Medicare/Coding/place-of-service-codes/New_or_Modified_Codes.html

I'm figuring it will probably be a waste of time, but I have to figure out something.  Turning away Medicare patients would be horrible

Michele:
I have not gone through that process.  The code that I was referring to is a just a small test, not a big part of the overall service so the doctor just bills the PC to Medicare. I will have to take a look at it though. 

Merry:
I am not a neuro biller but I am familiar with the procedure. Perhaps you can explain to me..(not a challenge question, just curious) how do you do the video part of the procedure in the patient's home? I have a grandchild that just went through this and was hospitalized so just curious if all of the components of this can be performed in the home setting. Again..only asking for an explanation if you would be willing to explain..curious how that would work.

And thank you for your commitment to us "elders"

Merry

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