OIG audit reminds telehealth providers that place is essential for payment

by: Julia Kyles, CPC Apr 17, 2018

Practices that offer — or are planning to offer — telehealth services should expect increased scrutiny of its claims and take three steps to avoid denials and overpayments:

According to the audit report published on April 13 by the HHS Office of Inspector General (OIG), of the telehealth claims the agency examined that were paid by Medicare in 2014 and 2015, “more than half" of professional claims "did not have matching originating-site facility fee claims.”

In other words, the physician or non-physician practitioner who performed the exam from the distant site submitted a claim for a telehealth exam with the appropriate distant site modifier, e.g., 99213-GT (Level 3 established patient office visit via interactive audio and video telecommunication systems). However, the originating site did not submit a claim for Q3014 (Telehealth originating site facility fee).

Don’t worry, clinicians who performed the exams will not be held responsible for the originating site’s failure to process the claim. However, they will be on the hook if the patient was not at an eligible originating site.

When the OIG took a closer look at 100 of the clinician claims, it found that CMS should not have paid for 31 of them. Of those claims, 87% failed the audit because the patient was at an ineligible originating site. When the agency extrapolated its findings, it concluded that Medicare made approximately $3.7 million in improper payments for telehealth services.

CMS agreed with the OIG’s recommendations: increase post-payment review of claims, ensure that Medicare administrative contractors implement existing claims audits, and educate providers who render telehealth services.

Blog Tags: CMS, OIG

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