Wiki Telehealth in Assisted Living and Home by Professional Provider

[CruzMich]

I bill for a primary care provider that has been performing telehealth visits for office patients and for our Assisted Living patients. I see Medicare will be changing the telehealth rule from billing modifier 95 with correct POS to a 02 for other than home and 10 for other than a hospital or other facility where the patient receives care in a private residence).
I am confused...
Are we not going to be able to bill telehealth for our assisted living?
When does this go into affect. First appears 12/14/23 and then they keep referencing the first of the year?
What is the audio only?

Can someone please clarify this for me? Thank you ahead of time.

 

[ckeeney]

Assisted Living services were moved to the Home services category for E&M billing and the description for POS 10 from CMS is: The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. In my opinion POS 10 would be appropriate for assisted living.
The E&M home category services are included in the CY 2024 telehealth services list, but audio-only is not allowed. The entire list can be downloaded from List of Telehealth Services | CMS
The Medicare rules are updated annually by Congress usually around November 1st and go into effect on January 1st of the following year, therefore these provisions take effect 1/1/24. (And just the kind of person I am, it is part of my favorite reading every year.)

 

[CruzMich]

YES, I am aware of the 01/01/2023 Assisted Living codes that were deleted and replaced with Home catagory services. I have been billing those.
I'm just concerned with the telehealth rule. I thought 10 would be appropriate however it states as follows: ● POS “10” - Telehealth Provided in Patient’s Home (Descriptor: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence). What I typed in BOLD is where I am baffled. Assisted LIving would fall under facility where the patient receives care in a private residence for some? Correct?

 

[ckeeney]

YES, I am aware of the 01/01/2023 Assisted Living codes that were deleted and replaced with Home catagory services. I have been billing those.
I'm just concerned with the telehealth rule. I thought 10 would be appropriate however it states as follows: ● POS “10” - Telehealth Provided in Patient’s Home (Descriptor: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence). What I typed in BOLD is where I am baffled. Assisted LIving would fall under facility where the patient receives care in a private residence for some? Correct?

I found this definition on the CMS website which I would interpret as meaning that assisted living is a private residence much like an apartment would be.

ASSISTED LIVING

A type of living arrangement in which personal care services such as meals, housekeeping, transportation, and assistance with activities of daily living are available as needed to people who still live on their own in a residential facility. In most cases, the "assisted living" residents pay a regular monthly rent. Then, they typically pay additional fees for the services they get.

 

[CruzMich]

YES, I am aware of the 01/01/2023 Assisted Living codes that were deleted and replaced with Home catagory services. I have been billing those.
I'm just concerned with the telehealth rule. I thought 10 would be appropriate however it states as follows: ● POS “10” - Telehealth Provided in Patient’s Home (Descriptor: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence). What I typed in BOLD is where I am baffled. Assisted LIving would fall under facility where the patient receives care in a private residence for some? Correct?

I found this definition on the CMS website which I would interpret as meaning that assisted living is a private residence much like an apartment would be.

ASSISTED LIVING

A type of living arrangement in which personal care services such as meals, housekeeping, transportation, and assistance with activities of daily living are available as needed to people who still live on their own in a residential facility. In most cases, the "assisted living" residents pay a regular monthly rent. Then, they typically pay additional fees for the services they get.

Thank you! I am going to agree with you.