OIG Report Finds Improper Billing for Telemedicine Services

As the push to increase the use of telemedicine grows, so too do concerns over questionable billing practices.

In a recently released report, the U.S. Department of Health and Human Services Office of Inspector General (OIG) found that the Centers for Medicare and Medicaid Services (CMS) paid practitioners for services that did not meet Medicare requirements.

To give you an idea of how much the use of telemedicine is growing, the OIG points out that in 2001, Medicare paid a total of $61,302 for telemedicine services. In 2015, that figure skyrocketed to $17.6 million.

Between 2014 and 2015 the watchdog agency reviewed 191,118 distant-site telemedicine claims that did not have corresponding originating site claims, totaling approximately $13.8 million.

Certain conditions must be met for providers to submit telehealth claims through Medicare Part B. For example, the originating site must be a practitioner’s office or a medical facility, not in a patient’s home, and the beneficiary must be located in a qualifying rural area.

OIG found that out of 100 sample claims reviewed, 31 claims did not meet Medicare requirements. It breaks down like this:

  • Twenty-four claims were unallowable because the beneficiaries received services at non-rural originating sites. In most instances, Medicare only covers telehealth services for patients at a rural originating site.
  • Seven claims were billed by ineligible institutional providers. The providers billed outpatient claims for telehealth services performed at distant sites for beneficiaries at rural originating sites, but the distant sites were not critical access hospitals and the services provided were not MNT.
  • Three claims were for services provided to beneficiaries at unauthorized originating sites. Two patients received the service from their home and the third from an independent dialysis center.
  • Two claims were for services provided by an unallowable means of communication. In one case, the service was provided via telephone and not through an interactive telecommunications system.
  • One claim was for a noncovered service, in this case crisis psychotherapy, which is not on the approved list of services.
  • One claim was for services provided by a physician located outside the United States. The physician in this case lived and practiced in Pakistan and provided psychiatric services to a patient at a rural medical center in the U.S.

The OIG figured that Medicare made approximately $3.7 million in payments that did not meet Medicare’s requirements.

The OIG noted that the problems happened because CMS did not ensure that (1) there was oversight to disallow payments for errors where telehealth claim edits could not be implemented, (2) all contractor claim edits were in place, and (3) practitioners were aware of Medicare telehealth requirements.

The OIG recommended that CMS (1) conduct periodic post-payment reviews to disallow payments for errors for which telehealth claim edits cannot be implemented; (2) work with Medicare contractors to implement all telehealth claim edits listed in the Medicare Claims Processing Manual; and (3) offer education and training sessions to practitioners on Medicare telehealth requirements and related resources. CMS concurred with all three recommendations.

As the use of telehealth grows, there’s a good chance healthcare professionals will undergo increased scrutiny. Indeed, OIG has said it is also conducting an audit of state Medicaid payments for telemedicine services, the results of which are due next year.

As a result, providers should make sure their telehealth programs and claims conform with Medicare requirements. The Health Law Offices of Anthony C. Vitale’s highly skilled team of experienced professionals can help you to ensure you are in compliance. Contact us for additional information at 305-358-4500 or send us an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.

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