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Back  RFI # 1394: POS12 and Facility Info

Formal vs. Informal Help Informal Formal

Submitter

David Krupla

Description

According to the 837P TR3 page 269, a service facility is required when the location of health care service is different from the billing provider's address. For Medicare Durable Medical Equipment, place of service 12 (home) is what is usually used. That would appear to make a service facility required for almost all claims for Medicare DME, with a patient's home address listed in the facility info and the patient's name listed as the facility name. Am I missing something here, or is that a correct interpretation?

Submitter Assigned Keywords

place of service 12 home facility

Response

This issue is explicitly addressed in the 5010 837 Professional implementation guide. The related 2310 Service Facility Location Name loop NM1 segment situation rule states for both guides "Required when the location of health care service is different than that carried in Loop ID-2010AA (Billing Provider). If not required by this implementation guide, do not send."

Therefore, if services are rendered in the patient's home and the patient's home address is not the same as the billing provider address then the Service Facility Location Name loop is required and must be completed by providers.

Recommendation

Since the entity identified in NM103 is defined as a non-person by NM102, It is recommended that a value such as “Residence” or a similar designation that identifies a non-person entity be reported in the NM103 of loop 2310C.
Submission 8/31/2011
Status Date 11/21/2011
Status F - Final
Primary References
Document 005010X222
Section2.4
Page269
Set ID837
Loop2310C