OIG: Practitioners billed $3.7M for telehealth services that did not meet Medicare requirements

A report from HHS' Office of Inspector General found nearly 31 percent of claims submitted between 2014 and 2015 did not meet the Medicare conditions for payment for telehealth services, which resulted in $3.7 million in excess payments.

Medicare paid a total of $17.6 million in telehealth payments in 2015, compared to $61,302 in 2001, according to the report. Because of this noted spike, OIG sought to determine whether CMS paid practitioners for telehealth services that met Medicare requirements.

The government watchdog group reviewed 191,118 Medicare-paid distant-site telehealth claims that totaled $13.8 million and did not have corresponding originating-site claims. Then, OIG reviewed a random sample of 100 claims, of which "24 claims were unallowable because the beneficiaries received services at nonrural originating sites, 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, one claim was for a noncovered service and one claim was for services provided by a physician located outside the U.S.," the report states.

OIG said the errors it found were the result of a lack of CMS oversight to ensure payments were not allowed for errors where telehealth claim edits could not be implemented, a failure to ensure all contractor claim edits were in place, and low awareness among practitioners of Medicare telehealth requirements.

"We recommend that CMS (1) conduct periodic postpayment 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," the report reads.

Click here to view the OIG's full audit report.

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