POS 10 in medical billing became a significant topic as the healthcare sector rapidly embraced telehealth to meet patients during the COVID-19 lockdown, which made it a need for the Centers for Medicare & Medicaid Services (CMS) to do the same. The agency proposed a temporary new Point Of Service (POS) code 10 for providers to bill telehealth service when they are seeing patients in their homes but ultimately declined to make it a permanent change.
The decision to use temporary policies, then more permanent policies, then back again, amid the public health emergency is still playing out and has created confusion among everyone involved. However, a recent CMS transmittal provides other guidance and assurances regarding billing Telehealth services.
CMS Transmittal 12671 (Change Request 13582), dated June 6th, provides Medicare Administrative Contractors (MACs) with guidance on how to adjudicate claims for covered telehealth services billed with POS 10. Telehealth services are those on the CMS List of Telehealth Services and are therefore “covered.” Effective Jan. 1, 2024, such claims will be paid at the Medicare Physician Fee Schedule non-facility rate, and the transmittal continues. This special rule does not apply to facilities at the origination site that bill a facility fee.
POS – Point-of-Service Medical Definition
One of the integral parts of the healthcare billing process is Point of Service. Which means that the place in which a healthcare service or procedure is being performed for a patient. The POS 10 in medical billing is used on medical claim forms (e.g., CMS-1500 form) to indicate where a service was performed. The codes are critical as they influence the reimbursement rates and how providers submit claims for payment to insurance companies or government healthcare programs such as Medicare and Medicaid.
POS 10 in medical billing codes are included in the standard codes used by healthcare providers for billing purposes. These code assists in determining what kind of service was performed and in what type of setting (for example, in a hospital provider’s office or nursing facility, etc.). The reason for this distinction is that reimbursement rates are often dictated by the location of service, and various rules and regulations apply depending on the care setting.
Key Purpose of POS Codes
Payment Location: Insurance companies and government programs typically pay for the same service differently, depending on where the service is provided. As an illustration, a procedure done in a hospital tends to have a higher reimbursement to a procedure in the office, reflecting the difference in facility overhead and resources.
Correct Billing: POS codes make certain that service providers are reimbursed correctly. The error in POS code assignment can result in a rejection of the claim or an improper reimbursement amount, which can halt payment cycles or result in a loss to the healthcare provider.
Compliance: Healthcare providers should be using the appropriate POS code in order to stay compliant for billing purposes. Coding or billing something wrong could lead to an audit or even penalties, or in some cases, an investigation into fraud, where the wrong code is being charged in order to obtain a higher reimbursement or where the Point of services is being misrepresented (URAC).
What is code 10 POS?
Payment for services provided is a crucial function in our healthcare system, also called medical billing. One of the most recently announced updates that has been creating a huge buzz is the addition of POS 10 in medical billing documentation. The new regulatory label of point of service is significant, particularly for telehealth services. Now, let us get into the details of POS 10, what its uses in medical billing, and how it is different from the other codes, especially POS 2.
What does POS 10 mean in medical billing?
POS 10 is a Point of service code that indicates a telehealth visit to a patient in their home. POS 10 in medical billing is different from the codes used previously in that it more accurately indicates remote care provided to a patient who is not located in a medical facility. As for CMS directives, POS 10 is used to bill and pay for telehealth services provided to a patient in their homes.
This code was released to meet the urgent need for telehealth as people seek treatment from their homes. Breaking out home-based Telehealth into its own bucket from other types of remote care sets up a structure for making claims processing more efficient while legitimizing the payer’s capacity to independently assess the nature of service delivery. And it fits neatly into the broader movement in the medical industry toward patient-centered designs, which focus on convenience and access.
Since payers will look at logs for proof of where services were provided, providers billing under POS 10 must keep complete logs as proof that eligible digital care was indeed delivered as intended. Further, POS 10 in medical billing recognizes telemedicine as a pivotal element of modern medicine that indeed enhances access but reduces costs. It also serves to keep legislators and stakeholders up to date with relevant developments by monitoring emerging practices.
POS 10 in medical billing is used when the patient is receiving Telehealth service while in their own home; visiting the patient services may be documented by the provider. With in-home virtual care versus over-the-phone virtual care, you will be able to differentiate location-based reimbursement closely, as this will be a line of demarcation that payers will be able to classify. With Code 10 POS, providers can ensure treatment settings match their claims, resulting in an increase in payments and fewer denials.
What Insurances are using POS 10?
Now, healthcare delivery is rapidly shifting to Telehealth, and in connection with that, we see more and more insurers using POS 10 for medical billing. They are not able to differentiate between home-based virtual visits and non-home-based virtual visits through the use of POS 10. The substance and tone of any one session can be radically different.
Unlike Medicare, private insurance companies have vastly different telehealth payment policies, but a trend developed over the past few months, one that recently reported more and more people without government insurance are realizing the benefits of virtual therapy. Real-time as well as delayed appointments with healthcare providers are meant to enable you to manage chronic illness and other aspects of your care — providing increased access to Telemedicine.
What is the difference between POS 2 and POS 10?
POS Workgroup is updating the description of POS code 02 and establishing a new POS code 10 to cater to the comprehensive industry requirements, as mentioned below:
POS 02: Telehealth Other Than in Patient’s Home
The setting in which health care and related services are delivered or transmitted, via telecommunication technology when patient is not at home.
POS 10: Home Telehealth
Where health services and health-related services are delivered or received through telecommunication technology. The patient is at home (which is somewhere other than a hospital or other facility where the patient receives care in a private home) when receiving health or health-related services or goods through telecommunication technology.
POS 10 and POS 2 The customers have POS invoices POS 2 and POS 10 invoices, and GRANCE identifies the gaps, yet they will never be created without GRANCE, so if you want to get paid through POS and your invoices will be correct, GRANCE is the solution. Indirectly, both are connected to telehealth, just in another way. POS 2 facilities provide remote assistance to patients being treated in a medical institution, such as a clinic or nursing home. In 2022, POS 10 will only look at whether Telemedicine improves outcomes from home. The big difference was the places where patients were treated.
What modifier to use with POS 10?
POS Code 10 refers to a Telehealth (Telemedicine) Service provided in a patient’s home. When submitting claims for telehealth services provided at home, it is important to use the correct modifier to ensure proper reimbursement and compliance.
The modifier commonly used with POS 10 is:
- Modifier 95: This modifier is used to indicate that a service was provided via real-time interactive audio and video telecommunication technology, which is necessary for telehealth services.
For example, if you’re submitting a claim for a telehealth consultation provided in a patient’s home, you would use:
- POS 10 (Telehealth provided in the patient’s home)
- Modifier 95 (Real-time telehealth service)
Together, these codes indicate that the service was provided remotely via telemedicine, allowing insurance companies and payers to understand that the service was delivered through telecommunication technologies.
Conclusion
Finally, using POS 10 in medical billing reflects the growing role of telehealth in modern medicine. Since the majority of insurance companies that know about POS 10 understand it, clinicians can adjust their practice. Well-implemented Code 10 POS offers not only financial sustainability but also promotes patient-centered care delivery. As telemedicine broadens its reach, the industry has embraced increased innovation. POS 10 is a tool for clinicians. An indicator, a metric, and a guidepost for billing as care continues to change.
With a focus on precision, compliance, and flexibility, providers can manage complications and broaden treatment pathways. Distinguishing between traditional office visits vs virtual care and using the appropriate modifiers to ensure both compliance and maximization. This means that the practitioner should accommodate the changes in the demands and the payment system as well as the establishment of telehealth, which recast the traditional approach of how medical service was delivered. Also learn more about how to ask for and understand billing codes.
FAQs for POS 10 in Medical Billing
1. What is POS 10 in medical billing?
POS 10 in medical billing refers to a Point of service code that identifies telehealth services provided to patients at their home. It is used when healthcare providers deliver services remotely through telecommunication technology, such as video calls or phone consultations, to patients who are in their homes. This code was introduced as part of the changes made to accommodate telehealth during the COVID-19 pandemic.
2. What is the point-of-service medical definition?
The point-of-service (POS) in medical billing refers to the location where a healthcare service is provided. It is a standard code used to identify whether the service was provided in an office, hospital, outpatient facility, or remotely (e.g., telehealth). POS codes are critical in determining reimbursement rates and ensuring proper billing for services rendered in different locations.
3. What is the difference between POS 2 and POS 10?
- POS 2 refers to telehealth services provided by a healthcare provider to a patient located in a different setting, such as a hospital or clinic. It is used when the service is not delivered in the patient’s home.
- POS 10, on the other hand, specifically refers to telehealth services provided to a patient in their home, where both the patient and provider interact remotely through telecommunication technologies.
4. What is code 10 POS?
Code 10 POS represents telehealth services provided in the patient’s home. It is part of the Point of service coding system, which is used to indicate the location where a service was rendered. Code 10 allows healthcare providers to bill telehealth services appropriately when the patient is not in a healthcare facility but is receiving care from home.
5. What insurances are using POS 10?
Many insurance companies, including Medicare and Medicaid, as well as private insurers, have adopted POS 10 for telehealth services provided to patients in their homes. The adoption of this code has become more widespread due to the increased use of telehealth services, particularly during the COVID-19 pandemic. Insurers have expanded telehealth coverage to ensure access to care while maintaining social distancing guidelines.
6. What modifier to use with POS 10?
When billing for telehealth services using POS 10, it is recommended to use modifier 95. This modifier indicates that the service was provided via real-time interactive audio and video communication. Modifier 95 is required to distinguish telehealth services from in-person services and ensures that the claim is processed correctly by insurance payers.