Correct Place of Service (POS) reporting is important when billing Medicare for physician services provided in skilled nursing facilities (SNFs) and nursing facilities (NFs).

Under CMS Change Request (CR) 13767, Medicare is reinforcing correct POS reporting after the Office of Inspector General (OIG) identified instances where practitioners did not report the appropriate POS code. Reporting POS 32 instead of POS 31 during a Medicare Part A-covered SNF stay can result in an overpayment.

Remember:

• POS 31 - Skilled Nursing Facility: Use for services provided to patients in a SNF during a Medicare Part A-covered stay.
• POS 32 - Nursing Facility: Use for services provided in an NF or in a SNF after the patient has exhausted Part A coverage.
• Mixed SNF/NF facilities: Use POS 31 unless the physician verifies that Medicare will not make a Part A payment.

Why It Matters

If a professional claim with POS 32 overlaps a previously processed claim for a covered Part A SNF stay, Medicare will reject the professional claim. If the POS 32 professional claim was already paid and Medicare later receives an overlapping SNF claim, the system will initiate an adjustment to the professional claim.

Billing Tip: Before submitting a claim for services provided in a SNF, verify the patient’s Part A coverage status. Part A-covered SNF stay = POS 31.

Use the Noridian Medicare Portal (NMP) to verify patient eligibility and if they are currently enrolled in a SNF stay.