HHS OIG Announces Review of Telehealth Payments

What does the recently announced Department of Health and Human Services (HHS) Office of the Inspector General (OIG) review of Medicare telehealth payments mean for the future of telehealth reimbursement? That’s the question that some advocates are asking following the announcement that the agency will be examining potential improper payments from the Centers for Medicare and Medicaid Services (CMS) to providers for telehealth services. As Inside Health Policy first reported, the investigation “will focus on claims for telehealth services provided at distant sites that do not match up with claims from an originating site.”

As we reported last month, the OIG review more broadly will seek to determine whether or not CMS wrongfully paid out more than $729 million to providers for the meaningful use of electronic health records (EHRs) and for telehealth services between 2011 and 2016. Following that review, the agency will be publishing a report that will include recommendations for telehealth reimbursement in the coming year. Telehealth experts, while noting that the investigation could add extra headaches for providers, largely told Inside Health Policy that it shouldn’t be taken as a sign that telehealth reimbursement is doomed in the future. “I think providers should almost celebrate that this is another sign of the legitimization of telehealth,” Foley & Lardner’s Nate Lacktman told the publication. He also speculated that the fact that “many patients are taking advantage of telemedicine in their own homes” could be behind the payment discrepancies. Some also questioned whether the investigation was an appropriate use of tax dollars. “Given the small amounts we’re dealing when compared to Medicare generally I’m not sure this is a good use of government resources,” said Rene Quashie, a member of the firm at Cozen O’Connor and a member of the CTeL Legal Resource Team. “The money could be better spent elsewhere.”

The investigation also underscores the importance of the research-driven work that the CTeL-led Telehealth Reimbursement Coalition is doing to help the Congressional Budget Office (CBO), the nonpartisan entity that assesses the potential fiscal impact of proposed legislation, understand why expanded reimbursement makes good financial sense. As Inside Health Policy noted, “the restrictions surrounding reimbursement complicate the billing process” when it comes to telehealth payments. The Telehealth Reimbursement Coalition’s work will help to bring much-needed clarity to the process.

Click here to read the article on the investigation into telehealth payments from Inside Health Policy (subscription required). 

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