Telehealth Certification Institute, LLC

OIG Audit of Medicare Payments for Telehealth Services

The Office of Inspector General is recommending that the Centers for Medicare & Medicaid Service (CMS) more closely review telehealth claims for adherence to requirements and offer education to providers to increase awareness of those requirements.

An audit of specific payments made to practitioners by the CMS for telehealth care shows that over 30% of claims did not meet Medicare requirements. This audit period focused on 2014-2015 and consisted of nearly 200 thousand payments, each of which included a fee for the distant site of care (location of provider) but no matching claim for the originating site (location of beneficiary). 31 claims of the 100 sample the services did not meet requirements. 24 of those were unallowable because the patients were not in rural originating sites. (For a summary of the study, please see: https://oig.hhs.gov/oas/reports/region5/51600058.asp)

Had these claims been filed properly and in adherence with Medicare guidelines, then well over $3 million could have been saved over that two-year time period. Now in 2018, telehealth care is a widely available option and it is pertinent that the CMS provide training for practitioners. Caregivers need to be fully informed of the Medicare requirements, both at the time of service and when they are processing their claims.

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