5: The procedure code/type of bill is inconsistent with the place of service
On Call Scenario:
Claim denied as the procedure code/type of
bill is inconsistent with the place of service
↓
May I get the denial date ?
↓
Could you please provide the correct place of service?
↙ ↘
If rep provides If rep refuses to provide
↓ ↓
What is the time limit to Could you please check,
send corrected claim? is there any paid hospital
↓ claim associated on same dos?
May I have the ↙ ↘
claim# and call ref#? No Yes
↓ ↓
What is the time limit ← What is the POS in
to send corrected claim? the hospital claim?
↓
Claim denied as the procedure code/type of
bill is inconsistent with the place of service
↓
May I get the denial date ?
↓
Could you please provide the correct place of service?
↙ ↘
If rep provides If rep refuses to provide
↓ ↓
What is the time limit to Could you please check,
send corrected claim? is there any paid hospital
↓ claim associated on same dos?
May I have the ↙ ↘
claim# and call ref#? No Yes
↓ ↓
What is the time limit ← What is the POS in
to send corrected claim? the hospital claim?
↓
May I have the claim# and call ref#?
Important Note:
- If the rep provides the correct POS then update it and send the corrected to insurance. Medicare does not accept the corrected claim, so always send fresh claims to Medicare.
- If the rep does not provide the correct POS then assign the claim to the coding team to review and provide the correct POS.
- Once a response is received from the coding team then work accordingly. When the response received as coding is correct then call insurance and try to reprocess the claim if the rep disagrees then ask for appeal details and send an appeal to insurance.
nice
ReplyDeleteThank you.
DeleteWhat will be the potf for a corrected claim?
ReplyDeleteIf the corrected claim is already billed within the time frame that got denied and you are going to send the correction again that is not under the time frame then you can consider the first billing of the corrected claim as POTF.
DeleteIf the corrected claim needs to be sent for the first time which is out of TFL then there is no POTF.
Thanks for your response, we will make the correction in the above post.
What is POTF
DeletePOTFL stands for proof of timely filing
DeleteHospital claims have revenue code and it is mentioned as POS which is wrong
ReplyDeleteNo, it is not wrong. On the hospital claim form (UB04 0r CMS1450), the revenue code defines the place where the service is rendered.
DeleteThank you for creating this website. It's is very helpful for new medical biller.
ReplyDeleteThank you!
DeleteWhich is correct place of service 99203 with modifier 95
ReplyDeleteYou can use POS 11.
Deletewhich is correct pos for RPM for heaalth first
ReplyDeleteIt is dependent on the location at which the billing physician maintains
Deletehis or her practice. If they are operating from office then it would be 11.
I am working as a RPM manager. We billed more than 270 claims to Health First New York with POS 11, and all are going to be denied due to an invalid place of service. And then we submitted a corrected claim with POS 2 again denied due to an invalid POS. We talked to the Health First Manager to resolve this issue, but he did not provide any solution to that, so we stopped billing for RPM service to the patient having Health First.
DeletePlease visit the following HealthFirst insurance link that may be helpful to you.
Deletehttps://hfproviders.org/documents/ReimbursementPolicy-PO-RE-074v1-Remote-Patient-Monitoring_FINAL.pdf
give us the flow chart for POS 11 12 13 14 15 like this as a fresher or exp person will get more clarity thanks :)
ReplyDelete