Advanced Search

Home Health & Hospice Week

Compliance:

OIG Adds Home Health Telehealth To Its Oversight List

Published on Fri Jan 29, 2021

Watch out: Telehealth scrutiny could hit hospice next.

A federal watchdog agency has trained its sights on a new home health topic — but the industry is wondering why.

The HHS Office of Inspector General added two new home health-specific topics to its Work Plan this month, including an “Audit of Home Health Services Provided as Telehealth During the COVID-19 Public Health Emergency.”

Under the PHE, the Centers for Medicare & Medicaid Services “waived certain requirements in order to expand Medicare telehealth benefits to health care professionals who were previously ineligible, including physical therapists, occupational therapists, speech language pathologists, and others,” the OIG notes on its Work Plan description. “CMS also amended regulations to allow home health agencies to use telecommunications systems in conjunction with in-person visits.”

Home health agencies have used telehealth visits more during the pandemic. Agencies “can utilize telecommu­nications to ‘supplement’ … care,” notes attorney Robert Markette Jr. with Hall Render in Indianapolis. CMS allows agencies to reduce “the amount of ‘in-person’ contact … with a patient by appropriately leveraging telehealth and remote patient monitoring,” Markette says.

This is especially helpful when facilities, families, or patients won’t allow in-person visits.

“When a phone call is made between visits, it is usually documented on a case conference,” observes Julianne Haydel with Haydel Consulting Services and The Coders.

However: HHAs “cannot count a telehealth encounter as a billable visit for home health, because of the Social Security Act’s requirement that a home health visit be in person,” Markette tells AAPC.

Accordingly, “home health agencies haven’t replaced many nursing visits with telehealth because the goal has been to provide visits as is necessary to the patient and no more due to payment considerations,” Haydel says.

CMS “amended regulations to allow home health agencies to use telecommunications systems in conjunction with in-person visits,” the OIG notes in its Work Plan item. “The amended regulations state that: (1) the use of technology must be related to the skilled services being furnished, and (2) the use of technology must be included in the plan of care with a description of how the technology will help achieve goals without substituting for an in-person visit.”

The OIG will “evaluate home health services provided by agencies during the COVID-19 public health emergency to determine which types of skilled services were furnished via telehealth, and whether those services were administered and billed in accordance with Medicare requirements,” the OIG says. “We will report as overpayments any services that were improperly billed.” The agency expects to issue the report next year.

The OIG isn’t expected to find much in the way of overpayments, since HHAs are not reporting telehealth visits on the claim, the experts say.

A bigger risk in this area is agencies ending up with a Low Utilization Payment Adjustment (LUPA) due to telehealth visits. They are more susceptible to LUPAs under 30-day PDGM billing periods already. “The key for agencies is to ensure that, when utilizing telehealth, they perform enough in-person visits to meet or exceed the LUPA threshold for that episode,” Markette notes.

Watch out: Don’t be surprised to see the OIG scrutinize telehealth in other areas, including hospice. CMS allowed hospice patients’ face-to-face physician encounters to be conducted via telehealth early on in the PHE (see HCW by AAPC, Vol. XXIX, No. 12-13).

“I have seen hospice F2F telehealth encounters documented,” Haydel notes. “The verbiage is pretty much the same, except for the physical exam which cannot be done.”

Hospices have struggled with furnishing in-person care to patients in facilities, leading CMS to clarify that hospices that can’t access their patients must discharge them (see HCW by AAPC, Vol. XXIX, No. 23).

Meanwhile: The OIG also listed “Home Health Agencies’ Challenges and Strategies in Responding to the COVID-19 Pandemic” as a new Work Plan topic. “This nationwide study will provide insights into the strategies HHAs have used to address the challenges presented by COVID-19, including how well their emergency preparedness plans served them during the COVID-19 pandemic,” the OIG says.

The OIG aims to issue this report in 2022 as well.

Note: The OIG Work Plan is at https://oig.hhs.gov/reports-and-publications/workplan/.

Other Articles in this issue of

Home Health & Hospice Week

View All