Is it proper use to use multiple POS to determine the reason for a bed hold day in Assisted Living billing?
Example, a Medicaid payer is requiring 2 different POS (12 - Home/Therapeutic and 31 - Hospital) in determining the reason for a bed hold while the resident is not at the facility overnight. The hospital and home POS have different addresses than what the billing provider (Assisted Living Facility) has which means a Service Facility Location is required [Situational Rule: Required when the location of health care service is different than that carried in Loop ID-2010AA (Billing Provider)].
How is this entered in the Service Facility loop when there can be 3 different POS on the claim?
The 837 professional TR3 (005010X222A1) provides for exactly one Place of Service Code per service line. This code is reported in SV105 (or CLM05-1 if SV105 is not present). The Place of Service Code identifies where the services were, or may be, performed.
Although there is only one Place of Service Code, there are multiple addresses that can be reported. The Billing Provider Address is required in loop 2010AA. The Patient Address is required in loop 2010CA (or 2010BA if loop 2000C is not present). If the Service Facility Location Address is different than the Billing Provider Address, the Service Facility Location Address must also be reported in loop 2420C (or 2310C if 2420C is not present).
Each claim service line accommodates one Place of Service Code and one Service Facility Location. The service location is only sent at the service line when the location where services were rendered is different from the location of the billing provider or the service location reported at the claim level.