Telemedicine, Hospitals, Physicians

What providers need to know about OIG’s plans to audit telehealth services

The Office of the Inspector General will audit Medicare Part B telehealth services to detect potential vulnerabilities and ensure compliance with regulatory requirements. To prepare, providers must first take stock of their programs and conduct audits of their own, experts say.

Providers and federal agencies quickly ramped up telehealth services in March last year when the Covid-19 pandemic hit the U.S. The government now wants to examine the telehealth services being provided to Medicare beneficiaries to identify vulnerabilities.

The Department of Health and Human Services’ Office of the Inspector General announced last week that it will conduct a series of audits of Medicare Part B telehealth services. This gives rise to two questions: what will the audits entail and what can providers do to prepare?

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The scope of the audits
The audits will be conducted in two phases. Phase one will focus on making an early assessment of whether services like evaluation and management, opioid use order, end-stage renal disease and psychotherapy meet Medicare requirements.

Phase two will include additional audits of services related to distant and originating site locations, virtual check-in services, electronic visits, remote patient monitoring, use of telehealth technology and annual wellness visits to determine whether Medicare requirements are being met.

The Centers for Medicare and Medicaid Services is looking to continue telehealth’s expanded role into the future. In its final physician fee schedule for 2021, the agency added more than 60 services to the Medicare telehealth list, which means they will be covered even after the Covid-19 pandemic has ended.

With this in mind, the OIG’s overarching goal is to detect possible weaknesses in the Medicare telehealth services being offered, said Donald White, a spokesperson for OIG, in a phone interview.

“Telehealth is an extremely valuable service, but there are potential vulnerabilities,” he said. “[We want to] come up with substantive information that will be of value to CMS going forward.”

Some of the risks associated with the rapid rise in telehealth use could include lack of provider documentation for services billed and not obtaining patient consent, said Leslie Slater and Christine Anusbigian, specialist leaders at consultancy firm Deloitte, in an email.

As the OIG looks into Medicare telehealth services, the scope of the audits may differ.

For the first phase, the OIG may just be looking to develop a set of recommendations, said Jacob Harper, an associate at law firm Morgan Lewis, in a phone interview. This means the agency will be conducting audits that are fairly limited in scope. They will likely look at five to 10 records per audit to identify the overarching issues in telehealth delivery.

Phase two could be a bit broader, however, Harper said. In this phase, the OIG may dig a little deeper into providers who are using telehealth services the most amid the pandemic.

Providers who do not meet Medicare requirements for the telehealth services listed above could fail the audits. These requirements include a set of both technical requirements and coding instructions, said Harper.

For example, OIG is likely to examine whether time-based codes have appropriate documentation showing time spent with the patient and whether the requisite level of decision-making is apparent in providers’ medical records for telehealth evaluation and management services, Harper explained.

“Failing to have appropriate clinical documentation of these items could lead to negative audit findings,” he said.

If providers fail the audits, they may be financially responsible for any overpayments identified, Deloitte’s Slater and Anusbigian said.

How providers can prepare
Knowledge is power for providers as they prepare for these audits. Harper, as well as Slater and Anusbigian, suggest that providers first conduct their own internal audits of their telehealth programs.

“Figure out what the issues are before someone asks,” Harper said.

Providers should perform compliance assessments and review claims and patient records to that confirm documentation meets the billing requirements for telehealth, Slater and Anusbigian said.

If documentation is missing, corrective actions should be taken, including updating EMR templates to capture required elements like the means of communication between provider and patient, they said. Further, providers should implement controls to ensure that claims are not submitted until documentation is complete.

Another step providers can take to prepare for the audits is to understand what the regulatory requirements were at the time the service was provided, Harper said.

“For telehealth services that have been rendered in the past year, that’s going to be really critical,” he said. “It’s been such a complex and ever-evolving framework for reimbursement in this area that that’s going to be something providers are going to want to know upfront.”

If providers can get a jump on understanding what the rules were when they provided specific telehealth services, they can defend claims if need be and avoid repayment requests, he added.

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