Sampling suggests nearly a third of Medicare telehealth payments are improper
- CMS paid about $3.7 million on telehealth claims that did not meet Medicare requirements, according to a new report by HHS Office of Inspector General.
- The OIG reviewed 191,118 distant-site telehealth claims from 2014 and 2015 totaling $13.8 million in payments. In a random sample of 100 claims, 31 failed to qualify for Medicare due to geographic and other restrictions.
- Of the 31 disallowed claims, 24 were because the patient received services in a nonrural setting. For example, one patient’s originating site was a doctor’s office in Lynchburg, VA, which is within a metropolitan statistical area.
With these findings, hospitals could see increased scrutiny over telehealth claims.
To qualify for a Medicare payment, healthcare services must be provided by a qualified originating site such as a hospital, rural health clinic or community mental health center, and the provider must be licensed to provide telehealth care. Moreover, communication between the patient and provider must be in real time and the service provided must be a covered service.
In addition to problems with originating sites, claims were flagged for using unacceptable means of communication and for billing services that Medicare didn't cover. In one case, a provider provided psychotherapy services that weren't approved for telehealth. In another case, the service was rendered via telephone rather than an interactive technology.
To avoid overpayments, OIG recommended that CMS periodically review claims following payment to catch possible errors. The watchdog agency also suggested CMS offer providers specific training on Medicare telehealth requirements.
The report comes as telehealth use is attracting providers and patients. According to a recent Mordor Intelligence report, the North American telehealth market will reach $16.8 billion by 2020, fueled by chronic diseases and rising healthcare costs. In a REACH Health survey, about 70% of healthcare leaders considered telehealth a high priority in their organization.
Reimbursement remains a major barrier to telehealth, both at the federal and state levels, but that’s starting to change. Recently, Congress passed and the president signed legislation extending telehealth access to Medicare beneficiaries with chronic conditions. The measure, part of the recent budget package, also encourages use of telehealth services in accountable care organizations.
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