Place of service: Provider-based settings away from hospitals to get their own POS code in 2016

Why This Topic Matters

Accurate location reporting can affect how outpatient services are classified on Medicare claims and how provider-based settings are distinguished from hospital-campus services. The article helps billing and compliance teams understand a change that may affect claim preparation, coordination between hospital and Part B billing, and internal location mapping.

Article Sections

1. New POS code for off-campus outpatient settings

   Introduces a Medicare place-of-service update for outpatient services provided away from the main hospital campus. Explains that the change affects how certain outpatient locations are identified on claims.

2. Campus definition and location determination

   Summarizes the regulatory framework used to distinguish on-campus from off-campus provider-based settings. Notes that organizations may need to verify how a location is classified for billing purposes.

3. Change foreshadowed in fee schedule

   Describes the earlier CMS discussion that led to the final reporting approach. Covers the agency’s broader effort to track provider-based outpatient services and the alternative approach it ultimately adopted.

4. Hospital claims get modifier PO

   Addresses how hospital-side claims are reported for off-campus provider-based services. Discusses coordination issues between hospital claims and Part B claims when the same location is involved.