11/07/2023

Medicare Recoupments POS 31/32

I have been getting multiple refund requests from Medicare for nursing home care. Apparently, my billing company was using POS 32 for all the patient and patients under a Medicare Part A stay should have had POS 31 used. This is amounting to thousands in refunds. I was unaware of the difference, but certainly Medicare would have known they were on a Part A stay when they paid and should have adjusted the claim instead of me accumulating 4 years of inappropriate payments. My billing company should have known also. I know ignorance is no defense, but is Medicare correct in doing this?

APMA and NYSPMA are aware that CMS and/or its Part B Contractors are recouping money from providers who submitted services that were performed for patients who were under a long-term nursing facility stay (Place of Service 32) using Place of Service 31 (Skilled Nursing Facility).  

These recoupments appear to be happening to many different provider types and throughout the country. APMA/NYSPMA staff, committees, and consultants are collecting information and strategizing an approach to CMS to discuss the fairness and appropriateness of these recoupments. Members who receive such a recoupment are encouraged to contact their administrative defense coverage carrier immediately.

If you are seeing patients in a nursing facility, it is important to include the correct POS (place of service) on your claims. This tends to be very confusing for podiatrists when they are billing for these types of services.

• POS 32-Nursing Facility
• POS 31-Skilled Nursing Facility

Difference Between POS 31 & 32

Customarily, the same facility may care for patients under both types of stay or care. The responsibility is then placed on the provider to determine the correct POS for each patient they care for.

POS 32

Patients who are under POS 32 are usually in the facility for long-term care.

POS 31

Patients who are under POS 31 have typically been transferred to a skilled nursing facility from a medically necessary inpatient hospital admission of at least three consecutive days within 30 days of discharge. The stay at a skilled nursing facility typically doesn’t last more than 100 days.

The OIG explains this recoupment at https://oig.hhs.gov/oas/reports/region4/42104084.asp.