tci Medicare Compliance & Reimbursement - 2013 Issue 9
Reader Question: Don't Change Inpatient POS for Radiology
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Article Overview
This article reviews updated CMS guidance discussed in MLN Matters MM7631 about place of service reporting when radiology interpretation and report services are involved. It is aimed at coders, billers, and compliance staff who need to understand how Medicare wants the service location reflected on claims, especially in hospital inpatient, hospital outpatient, provider-based, and office settings. The discussion centers on CMS policy direction and the general circumstances that affect POS reporting.
Why This Topic Matters
Accurate place of service reporting is important for Medicare claim submission and compliance. This article helps readers understand when the patient’s care setting controls POS reporting and when hospital or office circumstances change that reporting.
Article Sections
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Question
Introduces a reader question about Medicare place of service reporting when radiology is involved.
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Answer
Provides a general explanation of the CMS guidance and identifies that the topic relates to claim place of service reporting.
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Inpatient
Addresses the hospital inpatient setting and the related claim reporting context discussed in the article.
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Outpatient
Addresses the hospital outpatient setting, including discussion of provider-based department circumstances.
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Note
Clarifies the separate office setting on a hospital campus and its relevance to place of service reporting.
What You Will Learn
- How Medicare guidance addresses claim place of service reporting
- How inpatient and outpatient settings affect reporting considerations
- How CMS guidance referenced in MLN Matters applies to radiology-related billing
- Why office settings on hospital campuses may be treated differently from hospital settings
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Revenue cycle professionals
- Radiology billing staff
Codes Discussed
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