News: Most Medicare telehealth claims fail a documentation audit

More than half of the $13.8 million in Medicare telehealth payments examined by federal auditors fell short of reporting requirements, HealthLeaders Media reported.

Medicare telehealth payments include a fee paid to the clinician performing the service at a distant site, and an originating-site fee paid to the hospital or clinic where the patient receives the service.

The Department of Health and Human Services’ Office of Inspector General (OIG), however, focused an audit on the more than 191,000 Medicare distant-site telehealth claims totaling $13.8 million and filed between 1,015 and 2,014 that did not have the required corresponding originating-site claims, according to HealthLeaders Media.

Then, the OIG reviewed a sampling of 100 of those incomplete telehealth claims and found that 31 did not meet reporting requirements, according to the OIG report.

“We estimated that Medicare could have saved approximately $3.7 million during our audit period if practitioners had provided telehealth services in accordance with Medicare requirements,” the report says.

While the documentation was the culprit, the OIG laid the final blame on CMS, according to HealthLeaders Media, saying that the agency failed to ensure that:

• There was oversight to stop payments for errors where telehealth claim edits could not be implemented
• All contractor claim edits were in place
• Clinicians were aware of Medicare telehealth requirements

Further, the OIG recommended that CMS:

• Conduct periodic post-payment reviews to disallow payments for errors for which telehealth claim edits cannot be implemented
• Work with Medicare contractors to implement all telehealth claim edits listed in the Medicare Claims Processing Manuel
• Offer training sessions to clinicians on Medicare telehealth requirements

CMS has agreed to the recommendations going forward, HealthLeaders Media reported.

Editor’s note: This article originally appeared in HealthLeaders Media. To read the full OIG report, click here. To read about another recent OIG audit which uncovered incorrectly billed high-severity MS-DRGs, click here. To learn about how you can use the OIG’s work plan to focus your CDI efforts, click here.