At Home Status for Telehealth Encounters in Non-Telehealth Departments

You can select the "At Home" status of a patient during and after a telehealth visit that occurs in a non-telehealth department. The athenaOne rules engine uses this information to automatically select the appropriate Place of Service (POS) code to place on telehealth charge lines.

Prior to the COVID-19 pandemic, telehealth claims were traditionally billed with Place of Service 02. In 2022, CMS introduced an additional Place of Service code for telehealth (10) to specify that telehealth service was performed outside a facility (“in the patient’s home”), and payers have been increasing adoption of this code alongside 02.

Recently, CMS has ruled that starting on January 1st, 2024 the Place of Service will impact reimbursement, making the proper selection and submission of this code relevant for billing outcomes.

Currently, Place of Service is populated on the claim via several methods:

• The Service Department's Place of Service is used as the primary Place of Service for a claim.

• Individual charge lines can have their Place of Service (POS) manually adjusted on the Charge Entry page, the Visit and Claim Update page, and Claim Edit page.

• In cases where telehealth services are performed in departments set up for in-person services (e.g. Place of Service 11 – Office), several rules are in place that adjust the Place of Service for telehealth-specific charge lines.

This update enhances the last of these methods. Properly using the field from this update allows the rules engine to continue to adjust the Place of Service without manual intervention on each claim, allowing your practice to meet this billing requirement.

The default setting has two effects:

• For telehealth encounters in non-telehealth departments, the "At Home" status indicator will default to 02 if this setting is set to 02. Otherwise, it will default to 10 (even when off).

• For Collector-only practices who submit claims via interface (and thus do not have access to this field), we will use this setting to control the Place of Service automation for telehealth encounters in non-telehealth departments.

This default decision is set through the "Default Telehealth Place of Service" setting.

This setting is off by default. Your practice can have it set to "02" and "10", representing the two available Place of Service codes used for telehealth.

If your organization would like to enable this setting to "02" or "10", please contact the CSC using the process outlined in this Success Community article.

With the addition of this setting, we're working to remove the existing setting "Distant Site Telehealth POS 02 Automation"; if your practice uses this existing setting, please set the setting to your preferred value.

Note: During the time that they both exist, "Default Telehealth Place of Service" overrides the behavior of "Distant Site Telehealth POS 02 Automation" if applicable.

We've added the telehealth "At Home" status" field in two places:

• Within the Billing Tab — the Place of Service drop-down field has the Patient at home - 10 option.

• Within the "Reason for Visit" section that appears in several places within the encounter — Place of Service has two options:

  • Patient at home or other non-healthcare setting (POS - 10)

  • Patient at a facility (POS - 02)

The At Home status provides you with multiple opportunities to capture this information during the telehealth visit.

Note: The At Home status:

• Appears for telehealth visits (as defined by the “Telehealth” appointment type class) within non-telehealth departments (i.e. any department with a Place of Service other than 02 or 10).

• Defaults to "Patient at Home (Place of Service 10)".

As of January 1st, 2024, rules that previously automatically adjusted the Place of Service to 02 will now take this field into account, and will adjust the Place of Service accordingly.