This document lists place of service codes and descriptions that should be used on professional claims to specify where services were rendered. It notes that codes may have different reimbursement policies depending on the payer and provides a contact for comments. The codes are organized in a table with columns for place of service code, name, and description. Examples include code 11 for an office setting and 21 for an inpatient hospital.
Basic Steps to Start Process
1. Infrastructure………………………………………….
2. Medical Billing Software……………………………..
3. EDI Enrollment……………………………………….
4. Requirement from Provider End……………………...
5. Data Migration Procedure…………………………….
6. India-US roles………………………………………….
7. India Operation Set up Flow Chart…………………….
8. Data Transmission/ Work Execution Flow Chart……
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Basic Steps to Start Process
1. Infrastructure………………………………………….
2. Medical Billing Software……………………………..
3. EDI Enrollment……………………………………….
4. Requirement from Provider End……………………...
5. Data Migration Procedure…………………………….
6. India-US roles………………………………………….
7. India Operation Set up Flow Chart…………………….
8. Data Transmission/ Work Execution Flow Chart……
Dan Wellisch gave this presentation to the Chicago Technology For Vaue Based Healthcare Meetup at https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/
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Computerized physician order entry (CPOE), sometimes referred to as computerized provider order entry or computerized provider order management (CPOM), is a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care.
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Computerized physician order entry (CPOE), sometimes referred to as computerized provider order entry or computerized provider order management (CPOM), is a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care.
Healthcare Billing and Reimbursement: Starting from ScratchDale Sanders
The healthcare billing environment in the US is a disaster. It creates huge waste in care and cost. As presented at the Cayman Islands International Healthcare Conference in October 2010, this slide deck suggests what the billing system might look like, if we could start over.
A hospital is a healthcare organization that provides medical services and patient care. It is staffed by a team of medical professionals, including physicians, nurses, surgeons, and specialists, who work together to ensure the well-being of patients. The hospital's organization encompasses various departments such as emergency rooms, operating rooms, intensive care units, outpatient clinics, laboratories, radiology, and pharmacies. The hospital is responsible for patient admissions, discharge, triage, and maintaining patient safety through infection control measures. It operates within the framework of healthcare guidelines, accreditation, and regulatory compliance. Hospital management focuses on healthcare financing, budgeting, and ensuring proper staffing and resources. The hospital strives to provide patient-centered care, promote interdisciplinary collaboration, conduct research, and engage in community outreach and health education.
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Healthcare services
refer to a wide range of medical, preventive, diagnostic, and therapeutic activities provided by healthcare professionals to individuals or communities to promote and maintain their health, treat illnesses, and manage various healthcare needs.
Healthcare services encompass a broad spectrum of activities and can be delivered in various settings such as hospitals, clinics, nursing homes, home care, and other healthcare facilities.
Here are some key aspects and components of healthcare services:
Medical Consultation: Healthcare services often involve consultations with healthcare professionals such as doctors, nurses, and specialists. Patients seek medical advice, diagnosis, and treatment recommendations during these consultations.
Preventive Care: Healthcare services include measures to prevent diseases and promote health. This can include vaccinations, screenings, health assessments, and lifestyle counseling to encourage healthy habits and prevent the onset of illnesses.
Diagnostic Services: Healthcare services encompass diagnostic procedures and tests used to identify illnesses, injuries, or underlying medical conditions. These may include laboratory tests, imaging scans, biopsies, and other diagnostic tools.
Treatment and Therapies: Healthcare services involve providing treatment and therapies to address specific health issues. This can include medication administration, surgical interventions, physical therapy, occupational therapy, and other specialized treatments.
Emergency Care: Healthcare services cover emergency medical care provided in urgent situations, such as trauma, accidents, sudden illnesses, or life-threatening conditions. Emergency departments are equipped to provide immediate medical attention and stabilize patients.
Rehabilitation Services: Healthcare services extend to rehabilitation programs and services aimed at restoring function, mobility, and quality of life after an injury, surgery, or illness. These may include physical rehabilitation, speech therapy, occupational therapy, and other forms of rehabilitation.
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A Memorandum of Association (MOA) is a legal document that outlines the fundamental principles and objectives upon which a company operates. It serves as the company's charter or constitution and defines the scope of its activities. Here's a detailed note on the MOA:
Contents of Memorandum of Association:
Name Clause: This clause states the name of the company, which should end with words like "Limited" or "Ltd." for a public limited company and "Private Limited" or "Pvt. Ltd." for a private limited company.
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Registered Office Clause: It specifies the location where the company's registered office is situated. This office is where all official communications and notices are sent.
Objective Clause: This clause delineates the main objectives for which the company is formed. It's important to define these objectives clearly, as the company cannot undertake activities beyond those mentioned in this clause.
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Liability Clause: It outlines the extent of liability of the company's members. In the case of companies limited by shares, the liability of members is limited to the amount unpaid on their shares. For companies limited by guarantee, members' liability is limited to the amount they undertake to contribute if the company is wound up.
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Capital Clause: This clause specifies the authorized capital of the company, i.e., the maximum amount of share capital the company is authorized to issue. It also mentions the division of this capital into shares and their respective nominal value.
Association Clause: It simply states that the subscribers wish to form a company and agree to become members of it, in accordance with the terms of the MOA.
Importance of Memorandum of Association:
Legal Requirement: The MOA is a legal requirement for the formation of a company. It must be filed with the Registrar of Companies during the incorporation process.
Constitutional Document: It serves as the company's constitutional document, defining its scope, powers, and limitations.
Protection of Members: It protects the interests of the company's members by clearly defining the objectives and limiting their liability.
External Communication: It provides clarity to external parties, such as investors, creditors, and regulatory authorities, regarding the company's objectives and powers.
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Binding Authority: The company and its members are bound by the provisions of the MOA. Any action taken beyond its scope may be considered ultra vires (beyond the powers) of the company and therefore void.
Amendment of MOA:
While the MOA lays down the company's fundamental principles, it is not entirely immutable. It can be amended, but only under specific circumstances and in compliance with legal procedures. Amendments typically require shareholder
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POS Codes
1. Place of Service Codes for Professional Claims
Database (last updated September 10, 2007)
Listed below are place of service codes and descriptions. These codes should be used
on professional claims to specify the entity where service(s) were rendered. Check
with individual payers (e.g., Medicare, Medicaid, other private insurance) for
reimbursement policies regarding these codes. If you would like to comment on a
code(s) or description(s), please send your request to posinfo@cms.hhs.gov.
Place Place of Service Place of Service Description
of Name
Service
Code(s
)
01 Pharmacy** A facility or location where drugs and other medically
related items and services are sold, dispensed, or
otherwise provided directly to patients. (effective 10/1/05)
02 Unassigned N/A
03 School A facility whose primary purpose is education.
04 Homeless A facility or location whose primary purpose is
Shelter to provide temporary housing to homeless
individuals (e.g., emergency shelters, individual
or family shelters).
05 Indian Health A facility or location, owned and operated by the
Service Indian Health Service, which provides diagnostic,
Free-standing therapeutic (surgical and non-surgical), and
Facility
rehabilitation services to American Indians and
Alaska Natives who do not require hospitalization.
06 Indian Health A facility or location, owned and operated by the
Service Indian Health Service, which provides diagnostic,
Provider-based therapeutic (surgical and non-surgical), and
Facility
rehabilitation services rendered by, or under the
supervision of, physicians to American Indians and
Alaska Natives admitted as inpatients or outpatients.
07 Tribal 638 A facility or location owned and operated by a
Free-standing federally recognized American Indian or Alaska
Facility Native tribe or tribal organization under a 638
agreement, which provides diagnostic, therapeutic
(surgical and non-surgical), and rehabilitation
services to tribal members who do not require
hospitalization.
08 Tribal 638 A facility or location owned and operated by a
Provider-based federally recognized American Indian or Alaska
Facility Native tribe or tribal organization under a 638
agreement, which provides diagnostic, therapeutic
2. (surgical and non-surgical), and rehabilitation
services to tribal members admitted as inpatients or
outpatients.
09-10 Unassigned N/A
11 Office Location, other than a hospital, skilled nursing
facility (SNF), military treatment facility,
community health center, State or local public
health clinic, or intermediate care facility (ICF),
where the health professional routinely provides
health examinations, diagnosis, and treatment
of illness or injury on an ambulatory basis.
12 Home Location, other than a hospital or other facility,
where the patient receives care in a private
residence.
13 Assisted Living Congregate residential facility with self-
Facility contained living units providing assessment of
each resident’s needs and on-site support 24
hours a day, 7 days a week, with the capacity to
deliver or arrange for services including some
health care and other services. (effective
10/1/03)
14 Group Home * A residence, with shared living areas, where
clients receive supervision and other services
such as social and/or behavioral services,
custodial service, and minimal services (e.g.,
medication administration).
15 Mobile Unit A facility/unit that moves from place-to-place
equipped to provide preventive, screening,
diagnostic, and/or treatment services.
16 Temporary A short term accommodation such as a hotel, camp
Lodging ground, hostel, cruise ship or resort where the patient
receives care, and which is not identified by any other
POS code. (effective 4/1/08)
17-19 Unassigned N/A
20 Urgent Care Location, distinct from a hospital emergency
Facility room, an office, or a clinic, whose purpose is to
diagnose and treat illness or injury for
unscheduled, ambulatory patients seeking
immediate medical attention.
21 Inpatient A facility, other than psychiatric, which primarily
Hospital provides diagnostic, therapeutic (both surgical
and nonsurgical), and rehabilitation services by,
or under, the supervision of physicians to
patients admitted for a variety of medical
conditions.
22 Outpatient A portion of a hospital which provides
Hospital diagnostic, therapeutic (both surgical and
nonsurgical), and rehabilitation services to sick
or injured persons who do not require
3. hospitalization or institutionalization.
23 Emergency A portion of a hospital where emergency
Room – diagnosis and treatment of illness or injury is
Hospital provided.
24 Ambulatory A freestanding facility, other than a physician's
Surgical Center office, where surgical and diagnostic services
are provided on an ambulatory basis.
25 Birthing Center A facility, other than a hospital's maternity
facilities or a physician's office, which provides
a setting for labor, delivery, and immediate
post-partum care as well as immediate care of
new born infants.
26 Military A medical facility operated by one or more of the
Treatment Uniformed Services. Military Treatment Facility
Facility (MTF) also refers to certain former U.S. Public
Health Service (USPHS) facilities now
designated as Uniformed Service Treatment
Facilities (USTF).
27-30 Unassigned N/A
31 Skilled Nursing A facility which primarily provides inpatient
Facility skilled nursing care and related services to
patients who require medical, nursing, or
rehabilitative services but does not provide the
level of care or treatment available in a hospital.
32 Nursing Facility A facility which primarily provides to residents
skilled nursing care and related services for the
rehabilitation of injured, disabled, or sick
persons, or, on a regular basis, health-related
care services above the level of custodial care to
other than mentally retarded individuals.
33 Custodial Care A facility which provides room, board and other
Facility personal assistance services, generally on a
long-term basis, and which does not include a
medical component.
34 Hospice A facility, other than a patient's home, in which
palliative and supportive care for terminally ill
patients and their families are provided.
35-40 Unassigned N/A
41 Ambulance - A land vehicle specifically designed, equipped
Land and staffed for lifesaving and transporting the
sick or injured.
42 Ambulance – An air or water vehicle specifically designed,
Air or Water equipped and staffed for lifesaving and
transporting the sick or injured.
43-48 Unassigned N/A
49 Independent A location, not part of a hospital and not
Clinic described by any other Place of Service code,
that is organized and operated to provide
preventive, diagnostic, therapeutic,
rehabilitative, or palliative services to
outpatients only. (effective 10/1/03)
50 Federally A facility located in a medically underserved
4. Qualified Health area that provides Medicare beneficiaries
Center preventive primary medical care under the
general direction of a physician.
51 Inpatient A facility that provides inpatient psychiatric
Psychiatric services for the diagnosis and treatment of
Facility mental illness on a 24-hour basis, by or under
the supervision of a physician.
52 Psychiatric A facility for the diagnosis and treatment of
Facility-Partial mental illness that provides a planned
Hospitalization therapeutic program for patients who do not
require full time hospitalization, but who need
broader programs than are possible from
outpatient visits to a hospital-based or hospital-
affiliated facility.
53 Community A facility that provides the following services:
Mental Health outpatient services, including specialized
Center outpatient services for children, the elderly,
individuals who are chronically ill, and residents
of the CMHC's mental health services area who
have been discharged from inpatient treatment
at a mental health facility; 24 hour a day
emergency care services; day treatment, other
partial hospitalization services, or psychosocial
rehabilitation services; screening for patients
being considered for admission to State mental
health facilities to determine the
appropriateness of such admission; and
consultation and education services.
54 Intermediate A facility which primarily provides health-
Care related care and services above the level of
Facility/Mentall custodial care to mentally retarded individuals
y Retarded but does not provide the level of care or
treatment available in a hospital or SNF.
55 Residential A facility which provides treatment for
Substance substance (alcohol and drug) abuse to live-in
Abuse residents who do not require acute medical care.
Treatment Services include individual and group therapy
Facility and counseling, family counseling, laboratory
tests, drugs and supplies, psychological testing,
and room and board.
56 Psychiatric A facility or distinct part of a facility for
Residential psychiatric care which provides a total 24-hour
Treatment therapeutically planned and professionally
Center staffed group living and learning environment.
57 Non-residential A location which provides treatment for
Substance substance (alcohol and drug) abuse on an
Abuse ambulatory basis. Services include individual
Treatment and group therapy and counseling, family
Facility counseling, laboratory tests, drugs and supplies,
and psychological testing. (effective 10/1/03)
58-59 Unassigned N/A
60 Mass A location where providers administer
5. Immunization pneumococcal pneumonia and influenza virus
Center vaccinations and submit these services as
electronic media claims, paper claims, or using
the roster billing method. This generally takes
place in a mass immunization setting, such as, a
public health center, pharmacy, or mall but may
include a physician office setting.
61 Comprehensive A facility that provides comprehensive
Inpatient rehabilitation services under the supervision of
Rehabilitation a physician to inpatients with physical
Facility disabilities. Services include physical therapy,
occupational therapy, speech pathology, social
or psychological services, and orthotics and
prosthetics services.
62 Comprehensive A facility that provides comprehensive
Outpatient rehabilitation services under the supervision of
Rehabilitation a physician to outpatients with physical
Facility disabilities. Services include physical therapy,
occupational therapy, and speech pathology
services.
63-64 Unassigned N/A
65 End-Stage A facility other than a hospital, which provides
Renal Disease dialysis treatment, maintenance, and/or
Treatment training to patients or caregivers on an
Facility ambulatory or home-care basis.
66-70 Unassigned N/A
71 Public Health A facility maintained by either State or local
Clinic health departments that provides ambulatory
primary medical care under the general
direction of a physician. (effective 10/1/03)
72 Rural Health A certified facility which is located in a rural
Clinic medically underserved area that provides
ambulatory primary medical care under the
general direction of a physician.
73-80 Unassigned N/A
81 Independent A laboratory certified to perform diagnostic
Laboratory and/or clinical tests independent of an
institution or a physician's office.
82-98 Unassigned N/A
99 Other Place of Other place of service not identified above.
Service
* Revised, effective April 1, 2004.
** Revised, effective October 1, 2005