03/23/2022

Reimbursements by POS for Residents Seen at SNFs

I see residents at several SNF’s for routine foot care. Some are long term residents and for those residents I use pos code 32. The residents that I see who are admitted for subacute care ie. Less than 100 day stay, I use pos 31 The reimbursement for routine foot care is 50% less with pos code 31. Am I billing this correctly? Additionally, I perform the identical services to long term residents yet get reimbursed half the amount for these patients despite utilizing my own supplies and getting no assistance from the staff when I treat the residents in their rooms. In fact, I sometimes have to spend additional time trying to locate them as they may be st PT or elsewhere in the facility. Please advise. Thank you.

The difference in reimbursement is correct for Medicare or any other Medicare Advantage Plans. When charges are billed for the subacute nursing home setting under POS code 31, the services are reimbursed at the facility rate, which is typically lower compared to the reimbursement for an office, home, and other locations when reviewing the fee schedule for covered services. Long term nursing home accommodations under POS code 32 are considered a service location that is similar to a patient’s home and have a higher rate of reimbursement for the same RFC service. Even if no facility resources are being used and all supplies used to perform the foot care are not provided by the nursing home, services will always be paid less under POS 31 compared to POS 32. From a billing perspective, there would be no difference in coding with the procedures, regardless, if it is in an office, home, hospital, or other facility POS.