POS and Payment

Hello All,

I work for a multi-specialty billing office. We just recently opened a Priority Care office. I have never worked for "Priority Care" before. We currently bill with POS 20-Urgent care Facility, yet we have one payer that is requiring us to bill under POS 49-Independent clinic.

We only seem to have payment issues when using the POS 49. They are denying the E/M, but paying the minor procedure.

My thought was that the patient was not scheduled for this service, so with proper documentation we can bill the E/M with a 25 mod.

Has anyone else come across this in the past?

Thank you,

Megan

POS and Payment