POS 11 vs POS
22 in Medical
Billing
A comprehensive overview of healthcare POS
codes and their applications in medical billing
Introduction to POS Codes
POS (Place of Service) codes are used in medical
billing to identify the location where healthcare
services are provided. These codes are critical for
ensuring that claims are processed accurately and
reimbursed correctly.
Why are POS codes important?
- They help determine reimbursement rates.
- Correct POS code usage reduces claim denials.
- Ensures compliance with insurance
requirements.
POS 11 – Office Setting
POS 11 represents a physician's office or a similar outpatient
setting where services like routine exams, consultations,
vaccinations, and basic procedures are performed.
Examples of services covered under POS 11:
- Preventative exams (annual check-ups)
- Routine diagnostic testing (blood tests, X-rays)
- Minor procedures (minor surgeries, wound care)
Why use POS 11?
- Lower reimbursement rates compared to hospital settings.
- Simpler documentation requirements.
- Typically, lower overhead costs.
POS 22 – On-Campus
Outpatient Hospital
POS 22 refers to outpatient services provided on the campus of a
hospital. These services can include specialized care and facilities not
available in typical physician offices.
Examples of services covered under POS 22:
- Outpatient surgeries and procedures (e.g., joint replacements)
- Advanced diagnostic services (MRI, CT scans)
- Chemotherapy and other specialty treatments
Why use POS 22?
- Higher reimbursement rates than POS 11 due to more complex
services.
- Services provided in a facility that meets higher standards of care.
- Typically more specialized care with advanced medical technology.
Key Differences Between
POS 11 and POS 22
1. **Location**:
- POS 11: Services rendered in a physician's office or similar non-hospital
setting.
- POS 22: Services rendered in an outpatient hospital setting, typically
within a larger medical campus.
2. **Services**:
- POS 11: Basic and preventative healthcare services.
- POS 22: Advanced diagnostic and surgical services, outpatient surgeries,
and specialty treatments.
3. **Reimbursement**:
- POS 11: Typically lower reimbursements as these are considered less
complex services.
- POS 22: Higher reimbursements due to the complex nature of services
and facilities involved.
Correct Usage of POS
Codes
Using the correct POS code is crucial for:
- Accurate billing and reimbursement.
- Avoiding claim denials or delays.
- Complying with payer guidelines and regulations.
Best practices:
- Always verify the location where the services are provided
before selecting a POS code.
- Ensure that services match the level of complexity and the
setting.
- Review insurance payer requirements as they might have
specific rules for certain POS codes.
Common Billing Mistakes
and Solutions
1. **Incorrectly using POS 11 for services in a hospital**:
- **Mistake**: Coding outpatient hospital services with POS 11 when POS
22 should be used.
- **Solution**: Confirm whether services were provided on a hospital
campus and use POS 22 for accuracy.
2. **Using POS 22 for routine office visits**:
- **Mistake**: Billing a basic check-up or exam under POS 22.
- **Solution**: Verify that the service is hospital-based and complex
enough to justify POS 22.
3. **Lack of documentation**:
- **Mistake**: Insufficient details on services rendered leading to denials.
- **Solution**: Ensure comprehensive and accurate documentation for
each visit.
Best Practices for POS
Billing
- **Train staff regularly** on correct POS code
selection and the impact on claims.
- **Review the setting of care** and service
complexity before choosing the POS code.
- **Stay informed** on payer guidelines and any
changes in billing rules.
- **Audit claims regularly** to ensure accurate
billing and compliance with healthcare
regulations.
- **Use clear and precise documentation** to
avoid denials and delays in payments.
Conclusion
Understanding the difference between POS 11 and
POS 22 is crucial for healthcare providers to
ensure correct billing and maximize
reimbursements. Properly applying these codes
ensures:
- Accuracy in billing
- Compliance with payer requirements
- Optimized reimbursement and fewer claim
denials
Stay updated, train your staff, and implement
best practices to streamline your billing
processes.
Questions & Answers
Please feel free to ask questions or share any
additional insights on POS codes in
medical billing.
