POS 21 Definition in Medical Billing(2022)

POS 21 Definition

POS 21 is used for an inpatient hospital service. A facility that primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services under, the supervision of physicians to patients admitted for numerous medical conditions(Exclude psychiatric services) used this place of service code.

What is the ‘place of service’ code?

The place of service(acronym POS) code refers to a two-digit code designed by Centres for Medicare and Medicaid Services(CMS) and designated to almost every health care industry.

This code set is required to place on health care professional claims to indicate the place in which a service was rendered.

The importance of POS 21?

The POS code and information becomes mandatory in governing the acceptability of direct billing of Medicare, Medicaid, and private insurance services.

There is around 99 Place of service codes maintained by CMS, and each code has its functionality.

Note well-It is absolutely crucial that you submit the health care claims with the correct ‘Place of Service’ codes. Failing to do so might result in denial of the service, or it can trigger the deduction of the wrong fee amount in lieu of the billing claims to insurance companies.

POS 21(Inpatient hospital)

POS 21 or Place of Service 21 is that two-digit code used to specify an ‘Inpatient hospital,’ where services were rendered.

It withholds compiled facilities that provide the necessary healthcare services to the patients ‘admitted’ for different medical calls.

Under the supervision of maestro physicians and other healthcare workers, services such as therapeutic, surgical and non-surgical, diagnostic, and rehabilitation services(barring psychiatric support) are rendered.

Types of Inpatient hospitals

The following types of hospitals dispense the essential inpatient services:

  • Acute care hospitals(most common in type).
  • Community hospitals.
  • General hospitals.
  • Teaching hospitals.
  • Private non-profit hospitals.
  • Proprietary hospitals.

Types of Inpatient provisions

◆Initially, patients have earmarked any ward or a room based on the care they require. It can be a general ward or a semi-private room.

◆After the admission procedure is fulfilled and the patient is finally granted admission, the ‘Inpatient care’ comes into force.

◆The assistance included,

  1. Pediatrics
  2. Medicine
  3. Surgery
  4. Obstetrics-Gynaecology
  5. Orthopedics
  6. Oncology
  7. Dermatology
  8. ENT
  9. Rehabilitation

   10.Critical care units

   11.Diagnostics such as radiology, cardiology, etc.

The list continues

◆A team of healthcare professionals is assigned to meet patient’s specific medical needs.

◆Consequently, inpatients enjoy the benefits of having a network of doctors and other healthcare practitioners with shared concerns for their speedy recovery.

How health insurance companies cover Inpatient hospitalities?

Inpatient medical facilities are generally considered to those seeking ‘admission’ in a hospital that requires one or more days of an overnight stay at home.

More vividly, you need corresponding permission from a doctor to formally accept and reap the benefits of healthcare insurance coverage plans under the Place of Service 21 description.

It should also be ensured that the hospital has Medicare facilities.

Notes-Overnight stay at the ‘Emergency room’ for ‘Medical observation’ doesn’t make you an Inpatient.

However, in some insurance plans, your share of the cost for staying in the ’emergency room’ is covered if you are admitted to the hospital eventually.

Insurance expenses levied

◾️Inpatient cost is broken into two parts,

  1. Facility fee(general nursing care, semi-private room, medications, meals, hospital equipment, and services.
  • Fees allotted to surgeons/physicians.

◾️Any medicare is liable to cover the first 60 days of a hospital stay(after you have cleared your deductible amount.)

◾️After 60 days, a coinsurance cost comes into application.

◾️After 90 days, the bearing cost becomes the sole responsibility of the patient.

To end up

POS 21 is only worthwhile for patients who are registered officially into a respective hospital.

The insurance company takes the guarantee to cover all the pre-mentioned services. Sometimes, if there are allocations for extra services made, you may need to switch over ‘co-insurance’ strata.

However, you are advised to be very careful in selecting the correct ‘Place of Service’ code when relenting the claim to avoid denial.

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