Watchdog says nearly one-third of CMS telehealth payments were improper

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The growing drumbeat for greater use of telehealth in long-term care may have encountered a muffler.

Medicare's telehealth program is allowing too many payments to ineligible institutions and non-rural sites, according to a new report issued by the Department of Health and Human Services' Office of Inspector General.

The study examined a 100-claim sample from among nearly 200,000 telehealth claims paid to remote sites in 2014 and 2015, with outlays totaling $13.8 million.

Among those 100 cases, 31 claims did not meet requirements for the reimbursement that was provided.

Errors cited in the report include 24 claims that should have been rejected because beneficiaries received services at non-rural originating sites; seven claims billed by ineligible institutional providers, three claims for services from unauthorized originating sites; two claims were services provided using the wrong communication tools; one for a noncovered service; and one claim was paid to a non-U.S. physician.

The OIG extrapolated that Medicare could have saved about $3.7 million during the two-year audit period if practitioners had billed only for services in compliance with existing regulations.

Medicare paid a total of $17.6 million in telehealth payments in 2015 — 288 times as much as the $61,000 paid in 2001. Those payments include a professional fee, paid to the practitioner performing the service at a distant site, and an originating-site fee, paid to the facility where the beneficiary receives the service.

A survey conducted earlier this year by Sage Growth Partners, a healthcare research firm, found 44% of post-acute providers have yet to incorporate telehealth medicine.

Of those who haven't incorporated it yet, 86% said it's a priority. But many cited an uncertain reimbursement and regulatory landscape as a reason for delay.

The OIG has recommended CMS conduct periodic postpayment reviews to disallow payments for errors; work with Medicare contractors to implement all telehealth claim edits listed in the Medicare Claims Processing Manual; and offer education and training sessions to telehealth practitioners.