Insurance claims billing has never been an easy process.
However, while it is true that the process of claim filing is quite cumbersome because of a lot of seemingly unnecessary information that you need to specify, it is nevertheless critical. Insurance payers must be aware of all the specifics of the performed service to properly pay for it. They need to know all the whatabouts and whereabouts of procedures that you do.
Healthcare practitioners must indicate a place of service on each claim that they bill. According to the CMS guidelines, it can only be done by appending a specific universal Place of Service code (POS code). For example, in cases when a procedure has been rendered in an outpatient physician's office, a POS code 11 will be showing up on a claim. Currently, there are over 80 codes that can be used to indicate a location where a service has been rendered. Below are the most common places of service reported by our clients:
01 – pharmacy
02 – telehealth provided in places other than a patient’s home (effective January 1, 2022)
10 – telehealth provided in patient’s home
11 – outpatient physician office
12 – patient’s home
21 – inpatient hospital (any hospital other than psychiatric)
Now you may be wondering, “but why is it so important, don’t we already have a bunch of diagnosis codes and procedure codes that reveal pretty much the same?”. That’s the thing – the majority of ICD-10 and CPT codes can be reported for various places of service. For example, a service can be performed both at a patient’s home and at a provider’s office. And here comes the tricky part – some services are paid differently when reported with a specific place of service. Therefore, it is extremely important to append a proper POS code if you do not want to be underpaid or recouped in the future.
If you are an outpatient healthcare provider, you are using the CMS-1500 claim form to report your services. This form contains a field entitled “Place of Service”. It is referenced under box #24b. At the same time, inpatient providers do not need to indicate a specific place of service code on the UB-04 claim form, because there is simply no space for it. Instead, a type of bill needs to be displayed. The following types of institutional bill codes are the most common:
1 - Hospital
2 - Skilled Nursing
3 - Home Health
4 - Christian Science (Hospital)
5 - Christian Science (Extended Care)
6 - Intermediate Care
7 - Clinic
8 - Special Facility
WCH Service Bureau will take care of your billing regardless of its complexity! Contact us.