The medical billing industry requires a detailed understanding of codes, categories, and terminologies to ensure timely reimbursement and reduced denial errors. In the list of codes, Place of Service (POS) codes hold significant importance. It helps accurately identify the location where the service is provided. In addition, these codes are also essential for medical billers and coders to determine how medical services will be billed to insurance companies. The claim submission is made on CMS-1500 or equivalent
This detailed guide will explore POS 11 and POS 22 in medical billing, their usage, advantages, and common mistakes to avoid to ensure error-free reimbursement.
What are Place of Service (POS) codes, Its Types & Uses
Place of Service (POS) codes two-digit numeric codes used to indicate the physical location where the medical care is given. Simply put, when healthcare professionals including physicians and doctors deliver medical services, they provide it in a particular setting. It can be performed in a physical office, clinic, or any other facility. All of these facilities are denoted using particular codes to help ensure claims and reimbursement.
The Centers for Medicare and Medicaid Services (CMS) has standardized these codes. Furthermore, these codes are a part of the Healthcare Common Procedure Coding System (HCPCS). These codes, if used incorrectly, directly impact the billing process.
POS codes are divided into two categories
- Facility POS Codes
- Non-Facility POS Codes
Each code category plays an essential role in the claiming process. The healthcare provider receives reimbursement on service location.
Let’s understand each POS code category
Facility POS Codes
Facility POS codes determine the medical care provided in institutional or facility-based environments. These are typically large settings including hospitals, nursing homes, and skilled nursing facilities. Healthcare providers use appropriate codes to accurately inform where the service was given.
Facility POS codes are listed below:
- POS 21:Inpatient Hospital – When the patient is admitted and stays overnight in the hospital for medical care.
- POS 22: Outpatient Hospital – When the patient does not require an overnight stay and services are rendered in the out-patient department
- POS 23: Emergency Room-Hospital – When the patient is given services in the hospital’s emergency department.
- POS 31: Skilled Nursing Facility – When services are given in a skilled nursing facility with 24-hour care for recovering from injury, illness, or surgery
- POS 32: Nursing facility – when the patient requires long-term care in an assisted living facility or nursing home
By using the accurate POS facility code the insurance companies timely reimburse the claim without delays and denials.
Non-Facility POS Codes
The Non-facility POS codes determine that the medical care that is provided is not considered institutional. In other words, Non-facility POS denotes the settings that are outside of the hospitals. It includes the healthcare practice office, local clinics in nearby areas, and specialists for procedures. These POS codes help insurance companies determine the reimbursement in locations with low overhead costs.
Common Non-facility POS codes are listed below:
- POS 11: Office – when the services are provided in the provider’s office or any other private practice.
- POS 12: Home – when service is provided at the patient’s home including home care service and visits.
- POS 15: Mobile Unit – when the services are given in a mobile unit such as a mobile health clinic or lab.
- POS 17: Walk-in Retail Health Clinic – When the service is given in a walk-in retail clinic including a grocery store, pharmacy, or retail location. It is typically for a minor illness.
- POS 20: Urgent Care Facility – When the service is provided in a non-emergency clinic designed to provide immediate care.
- POS 50: Federally Qualified Health Center (FQHC) – when service is provided at a community health center funded ferally.
Use of POS codes by biller and coder in medical billing services
Medical biller and coders plays an essential role in the correct use of POS codes. The correct use of the Place of Service code demonstrates the facility setting. If the biller and coder use improper or incorrect codes it will lead to claim denial and or delay. So, healthcare providers must provide the accurate code in correct order to the billers and coders. POS codes, if used properly, result in accurate reimbursement from insurance companies such as Medicare and Medicaid.
What is POS 11 in Medical Billing?
POS 11 is a code that indicates the healthcare services are provided in the physician’s office. It includes general and special medical practices and any specialty clinic with outpatient service. POS 11 indicates that the medical care is given in the personal setting of the healthcare provider. It is typically for routine checkups, consultations, minor dermatology, and outpatient procedures that do not require a stay.
If the doctor’s office is independently operated on the hospital premises it will be highlighted with POS 11 code. The two important factors are listed below where the POS 11 code will be implemented:
- If the doctor pays the rent and employees are working in the doctor’s facility
- The doctor’s organization has a separate Tax ID
Advantages of POS 11
- Ease of use in the billing and reimbursement process
- User-friendly interface with less time on administrative tasks
- Accurate POS code enhances financial stability and reduces errors
- System integration with verification reduces claim denials and accurate billing information for submission
- Faster reimbursements and lower the errors
What Are Common Mistakes You Should Avoid While Using POS 11?
Healthcare providers sometimes use incorrect POS codes in the CMS 1500 form. Here are some common mistakes that you must avoid while using POS 11:
- Misuse of Codes: Using POS 11 code when the service was not performed in the physician’s office setting
- Incorrect Modifier Application: Using incorrect modifiers leads to claim denials.
- Failure to Update Information: If the healthcare provider does not update the information of the service rendered, it will lead to errors and ambiguity.
What is POS 22 in Medical Billing?
POS 22 demonstrates the delivery of medical care in outpatient settings, clinics, or hospitals. It records the services given in large facility settings.
Advantages of POS 22
- Accurate Claims: It ensures outpatient hospital services are accurately billed and submitted for claim and reimbursement process
- Proper Reimbursement: Outpatient services are reimbursed at a higher rate. Thus, its proper reimbursement is necessary for financial compensation.
- Compliance: Accurate POS code complies with the payer’s requirement to reduce claim denials and rejections.
What Are Common Mistakes You Should Avoid While Using 22?
- Incorrect Location Classification: if the service is given other than outpatient service in any private clinic then using POS 22 will lead to incorrect billing and error.
- Billing Errors with Multiple Providers: If not combined properly,
- service provided by multiple providers but in different settings leads to discrepancies.
- Misapplication of CPT Codes: POS 22 with incorrect CPT leads to claim rejection and denial
Comparison of POS 11 vs POS 22
Aspect | POS 11 | POS 22 |
Description | Service provided in doctor’s office | Service provided in outpatient |
Typical Settings | Specialty clinics and private practice | Hospitals, outpatient departments, surgical centers |
Reimbursement Rates | Lower | Higher |
Common Uses | Regular checkups, special consultations, or minor care | Minor surgeries, diagnostic tests, and emergency treatment |
Common Mistakes | Incorrect modifier and misuse of code | Incorrect CPT code pairing |
Best Practices For Using POS 11 and POS 22
Here are best practices while using POS 11 and POS 12
- Regular Staff Training: Billers and coders must be well-trained in the usage of POS 11 and POS 22.
- Correct Documentation: Use accurate codes and details where exactly the medical service was given.
- Stay Updated: Billing regulations and POS codes can change. So, always stay updated with the latest coding standards.
- Regularly Review Audit: Conduct regular audit reviews and detect errors, if there are any.
Frequently Asked Questions (FAQ’s)
1. Can POS 11 and POS 22 be used together?
No, POS 11 and POS 22 cannot be used together. Each code belongs to a specific healthcare setting.
2. Do insurance companies reimburse at the same rate for POS 11 and POS 22?
No, the rate varies for POS 11 and POS 22. Services billed under POS 22 for outpatient settings are reimbursed at high rates. Conversely, POS 11 has lower rates.
3. What happens if I use the wrong POS code?
Using the wrong POS code will lead to claim rejections, payment delays, or improper reimbursement. It can create compliance issues with insurance companies
4. Is there a limit to the number of times I can use POS 11 or POS 22 in a month?
No, there is no limit to using POS 11 or POS 22 codes. However, it is essential to use the appropriate code where the services were given.
Conclusion
To conclude, POS 11 and POS 22 are essential in medical billing services. These codes are widely used in the USA healthcare. They enhance the effectiveness and operational success of billing processes. The codes classification of POS 11 and POS 22 inform the billers, coders, and insurance companies about the facility setting. In addition, using correct codes and staying updated on the list ensure timely and error-free claims. Thus, to smoothly navigate the complex medical billing world detailed coding knowledge is essential.