An audit by the Office of the Inspector General (OIG) for the Department of Health and Human Services found flaws with almost a third of claims submitted to Medicare for telehealth services, a field of treatment the federal health program keeps expanding after seeing significant recent gains in its use.
Moving forward, though, the agency intends to implement some improvements to its reimbursement model.
An examination of a stratified random sample of 100 claims for telehealth services found that 31 of them did not meet Medicare requirements, said the OIG in an April report. Medicare covers telehealth as part of its effort to support access to care in rural areas, paying for interactive videoconferencing between a patient located at a certified originating site and a clinician located at a distant site.
The OIG’s review found 24 claims covering services in what it terms “nonrural” settings at sites that were not participating in a Centers for Medicare and Medicaid Services (CMS) demonstration program. In one case, for example, a patient’s originating site was a physician’s office in Lynchburg, Virginia, which falls within a metropolitan statistical area (MSA). MSA is a term the federal government uses to broadly define areas dominated by cities and their suburbs.
Another seven claims were billed by ineligible institutional providers, three claims were for services provided to beneficiaries at unauthorized originating sites, two claims were for services provided by an unallowable means of communication, and one claim was for a noncovered service. In another flawed claim, a physician residing and practicing psychiatry in Pakistan provided counseling services through telehealth technology to a patient located at a rural medical center in the United States.
Telehealth Expanding
The claims studied were drawn from a pool of 191,118 Medicare-paid telehealth claims, totaling $13.8 million, that did not have corresponding originating-site claims.
Based on the sample results, the OIG estimated that Medicare could have saved approximately $3.7 million over the 2014 – 2015 period if practitioners had stuck with Medicare requirements for telehealth services.
Medicare spending for telehealth services has expanded notably in recent years, jumping to a total of $17.6 million in payments in 2015 compared with $61,302 in 2001. CMS agreed with the OIG’s three recommendations on telehealth payments:
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Do periodic reviews to disallow payments for errors for which telehealth claim edits cannot be implemented
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Work with Medicare contractors to implement all telehealth claim edits listed in the Medicare Claims Processing Manual
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Offer education and training sessions to clinicians
In her letter to the OIG regarding the report, though, CMS Administrator Seema Verma signaled strong agency support for care provided at a distance.
“CMS is expanding the services that can be provided as Medicare telehealth services and reducing the administrative burden for health care providers to bill for these services” Verma wrote. “Improving access to telehealth services reflects CMS’ work to modernize Medicare payments to promote patient-centered innovations.”
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