OIG Plans to Focus on Medicare Part B Payments for Telemedicine

The Department of Health and Human Services Office of Inspector General, (HHS OIG) recently announced a new project designed to review Medicare Part B payments for telemedicine services. It’s part of the OIG’s Work Plan initiatives released last November and updated monthly.

Among the June/July updates, the agency noted it will be looking to see if healthcare professionals are providing telehealth services to Medicare Part B patients at an approved originating site.

Medicare Part B covers expenses for telehealth services on the telehealth list when those services are delivered via an interactive telecommunications system, provided certain conditions are met:

  • The services are on the Medicare telehealth list
  • The services are provided through live, interactive videoconferencing between a beneficiary located at a rural originating site and a practitioner located at a distant site;
  • An eligible originating site must be the practitioner’s office or a specified medical facility, not a beneficiary’s home or office.

The IG has said it will review Medicare claims paid for telehealth services provided at distant sites that do not have corresponding claims from originating sites to determine whether those services met Medicare requirements.

As the popularity of telemedicine continues to grow, lawmakers have been working to reduce the limitations on Medicare Part B coverage of and reimbursement for telemedicine services. A number of bills have been introduced in recent months to address many issues that come with the growth of telemedicine.

One such example is the Medicare Telehealth Parity Act of 2017 which was introduced in May. It would provide an incremental expansion of coverage for telehealth services under the Medicare program by expanding the number of acceptable geographic locations for telehealth coverage under three “phases.”

Another example is the HEART Act, which proposes to increase Medicare coverage of telehealth services, including coverage and payment for store-and-forward services delivered to “any telehealth services that are furnished from a distant site, or to an originating site, that is a critical access hospital . . ., a rural health clinic . . ., or a sole community hospital” and for home-based monitoring of congestive heart failure and chronic obstructive pulmonary disease.

And, just last month the Evidence-Based Telehealth Expansion Act of 2017, was introduced by Reps. Doris Matsui, D-Calif., and Bill Johnson, R-Ohio. It would allow the HHS secretary to review Medicare services and determine which are appropriate for telehealth. It would also authorize the HHS secretary to waive existing restrictions on those services if they reduce cost while maintaining or improving quality.

As the popularity of telemedicine increases we can expect more regulation of the industry. The Health Law Offices of Anthony C. Vitale can assist all provider types with telemedicine compliance, billing and reimbursement guidance.

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