Medicare Compliance & Reimbursement

But: The statistics also highlighted certain inequities despite the increase in implementation and utilization, the report says. “While these expansions lead to large increases in telehealth use, the extent of the increase varied across geographic and demographic groups. These differences may be driven by a number of factors, including access to broadband internet, varying state-level policies on the delivery of telehealth across state lines and the timing and degree to which the pandemic affected geographic areas differently.”

Resource: Review the “Medicare Telehealth Trends” report, methodologies, snapshots, and more at https://data.cms.gov/ summary-statistics-on-use-and-payments/medicare-service-type-reports/medicare-telehealth-trends.

2. OIG Report Reveals Telehealth Risks During Pandemic

The HHS Office of Inspector General (OIG) has vigilantly pursued telehealth fraud and abuse since the PHE began. Now, the nation’s healthcare watchdog has released a report on its findings, including risks to the Medicare program and advice on how to fix the issues.

Lowdown: On Sept. 2, OIG released the report, “ Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks,” which analyzed the telehealth billing practices of 742,000 Medicare FFS and Medicare Advantage providers between March 1, 2020 and Feb. 28, 2021.

OIG developed seven measures to determine fraud risks — and identified 1,714 Medicare providers with outlier behavior, the report noted.

“Although these ‘high risk’ providers represented a small percentage of the total number of providers included in the Draft Report, these ‘high risk’ providers submitted claims for approximately 500,000 Medicare beneficiaries accounting for $127.7 million in Medicare fee-for-service payments,” explain attorneys Janet K. Feldkamp, W. Clifford Mull, and Lianne M. Foley with law firm Benesch in online legal analysis.

Take a look at the measures that OIG used to identify risks, according to the report:

1. Billing for both a telehealth service and a facility fee for the majority of visits;
2. Billing telehealth services at the highest, most expensive level every time;
3. Billing telehealth services for a high number of days;
4. Billing both Medicare fee-for-service and a Medicare Advantage plan for the same service for a high proportion of services;
5. Billing a high average number of hours of telehealth services per visit;
6. Billing telehealth services for a high number of beneficiaries; and
7. Billing for a telehealth service and ordering medical equipment for many of their beneficiaries.

Even though some Medicare providers fell into the high-risk zone, that doesn’t necessarily mean their billing behavior was deemed fraudulent or abusive. “We designed this study to identify telehealth providers who warrant further scrutiny,” explained OIG.

However, the data did uncover a myriad of issues that the agency intends to continue to monitor and advise CMS on.

For example, OIG recommended more transparency surrounding incident-to billing for telehealth services because it’s harder to pinpoint which provider administered the services. “For this reason, CMS should require the use of a modifier to indicate ‘incident to’ telehealth services when clinical staff primarily delivered the service billed under the supervising practitioner’s identification number,” OIG urged in the report. “To do so, CMS should create a service code modifier.”

Plus: This isn’t the only fraud advice that OIG has published on telehealth services during the pandemic. In fact, the agency issued the “Special Fraud Alert: OIG Alerts Practitioners To Exercise Caution When Entering Into Arrangements With Purported Telemedicine Companies” on July 20, 2022. Additionally, OIG has several Work Plan active items on the topic and continues to bring enforcement actions against telehealth services fraudsters.

“Prudent providers will carefully monitor services to assure compliance with appropriate delivery requirements and billing of quality telehealth services,” Feldkamp, Mull, and Foley say.

Resources: Check out the report at https://oig.hhs.gov/ oei/reports/OEI-02-20-00720.pdf. View the special alert at https://oig.hhs.gov/documents/root/1045/sfa-telefraud.pdf. Find at the Work Plan items on telehealth at https://oig.hhs.gov/reports-and-publications/workplan/active-item-table.asp#example=ftelehealth.

3. OCR Offers Tools to Circumvent Telehealth Inequity

The pandemic revealed systemic health inequities, including access to quality healthcare and innovative technologies. That’s one reason why the feds recently issued new guidance that aims to cut discriminatory practices in the telehealth services realm.

On July 29, the Department of Health and Human Services (HHS) in collaboration with the Department of Justice (DOJ) announced new guidance to commemorate the 32nd anniversary of the Americans with Disabilities Act (ADA). The tools aim to protect the rights of people with disabilities and limited English proficiency and ensure their access to telehealth.

“Telehealth has become an evolving and common pathway for accessing healthcare, particularly as our society becomes increasingly digitized,” explains Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division in the release. “It is critical to ensure that telehealth care is accessible to all, including patients with disabilities, those with limited English proficiency, and people of all races and national origins.”

The HHS Office for Civil Rights (OCR) and DOJ-OCR worked together on the guidance, which explains the obligations providers have regarding telehealth services as well as their patients’ rights to these important technologies. “The guidance provides examples of actions that may be discriminatory and describes steps that providers may need to take to ensure that health care offered via telehealth is accessible. The guidance also provides a list of resources that providers and patients may wish to consult for additional information about telehealth and civil rights protections,” HHS expounds.

Resource: See the guidance at www.hhs.gov/sites/default/files/guidance-on-nondiscrimination-in-telehealth.pdf.