Unnoticed Medical Billing Changes in 2023

 



While not every policy alteration by the Centers for Medicare & Medicaid Services (CMS) grabs headlines, it’s often these less-publicized changes that lead to the most billing complications. Here are a couple of recent adjustments made by CMS that you might have overlooked.

New Place of Service Code

CMS introduced a new Place of Service (POS) code, 27, specifically for Outreach site/street locations. This code went into effect on October 1, but Medicare Administrative Contractors (MACs) have until January 1, 2024, to incorporate POS 27 into their claims processing systems.

The official definition for POS 27 is: “A non-permanent location on the street or in a non-standard environment, not classified under any other POS code, where healthcare professionals offer preventive, screening, diagnostic, and/or treatment services to homeless individuals without shelter.

In Transmittal 12202, CMS Provides Rationale for Establishing POS 27 for Medicare Part B Claims

At the behest of industry stakeholders, this fresh code was requested and subsequently established. Its purpose is to serve as a tool for recognizing care delivered to individuals who may encounter difficulties in accessing conventional healthcare facilities. Moreover, it holds the potential to enable the monitoring of care administered at outreach sites.

November Revision of Remittance Advice Remark Codes and Claim Adjustment Reason Codes

When reviewing the explanations of benefits from MACs, you might come across Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs) that are unfamiliar to you. CARCs offer insights into claim remittance processing, while RARCs provide supplementary details about CARCs.

As of November 1, the latest RARCs have been added to the X12 website, as depicted in the figure below. These codes cover electronic requests for additional information, real-time claim processing, unmet electronic visit verification data element requirements, reaching the maximum allowable payment, and the rejection of the Delay Reason code.


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