The spike in Medicare claims for telemedicine appointments drew the attention of federal watchdog agencies. Regulators wanted to be sure that billing practices in the telehealth realm were following prescribed guidelines, especially given the fact that so many providers were still relatively new to telemedicine protocols.
The Centers for Medicare & Medicaid Services (CMS) undertook an audit “to determine whether the dramatic increase in telehealth
services during the COVID-19 Public Health Emergency presents a significant program integrity risk to the Medicare program.” CMS identified seven billing practices that it deemed “inappropriate,” including billing both a telehealth service and a facility fee for visits or billing a high average number of hours of telehealth services per visit.
The audit results showed a high level of compliance with billing practices among telehealth providers. Of the 741,750 providers who submitted telehealth claims to Medicare from March 1, 2020 to February 28, 2021, only 0.0023% were found to have violated one of the seven improper billing practices. Even so, HHS’s Office of Inspector General recommended “targeted oversight” of telehealth billing so as to “minimize integrity risk while ensuring patient access to the benefits of telehealth.”
“I was hoping that we would not see patterns of abuse or systemic abuse,” says Faisal Khan, senior counsel and civil fraud investigation practice lead at Nixon Gwilt Law, the nation’s premier law firm specializing in health care innovation. “There might have been a perception that there was risk for fraud or rampant abuse, but the data from this audit indicates that people want to do the right thing. There’s always going to be an outlier that tries to bend or break the rules. But I think when you’re a professional, and you agree to certain professional ethics and requirements as a Medicare-Medicaid provider, you have to follow the rules as the failure to do so could have life-changing negative consequences.”
Khan believes that the audit has helped to validate telemedicine as a long-term alternative to in-person health care appointments. The fact that CMS did not feel the need to make wholesale recommendations that would alter current practices underscores the finding that telehealth is a viable and sustainable option for providers and patients on Medicare.
“The results of the audit should give providers comfort,” Khan says. “As long as practitioners are providing a legitimate, medically necessary service, documenting the service appropriately as they would for any service, then they should take comfort that CMS is not seeing the need to take immediate action.”
Khan also says that the audit should cause providers who are not offering telehealth options to ask why they are not doing so. “Patients are potentially receiving these services from your competitors, which begs the question as to whether you need to get in the game.”