On January 26, 2021, the United States Department of Health and Human Services Office of Inspector General (HHS OIG) announced a new telehealth-related audit targeting Medicare Part B services. The announcement notes that OIG will conduct these audits in two phases.
The first phase will focus on making an early determination of whether services “such as evaluation and management, opioid use disorder, end-stage renal disease, and psychotherapy” meet Medicare requirements.
The second phase will then delve deeper into a broader range of Medicare Part B telehealth services, including “distant and originating site locations, virtual check-in services, electronic visits, remote patient monitoring, use of telehealth technology, and annual wellness visits.”
Home Health Agencies
The same day, HHS OIG also announced an audit targeting the implementation of telehealth waivers (Section 1135 waivers) by home health agencies during the COVID-19 public health emergency. These waivers expanded the range of healthcare professionals who can provide Medicare-covered telehealth services to physical therapists, occupational therapists, speech language pathologists, and other non-physician practitioners.
However, 1135 waivers do not traditionally allow for telehealth services to be paid for home health claims. Due to the extraordinary circumstances presented by the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) amended the regulations on an interim basis to allow for the payment of telehealth services on home health claims, in conjunction with in-person visits.
The interim rule was finalized in the CY 2021 Home Health Prospective Payment System Final Rule, requiring the plan of care to include any provision of remote patient monitoring o rother services furnished via telecommunications technology or audio-only technology, and that such services must be tied to patient-specific needs as identified in the comprehensive assessment. The final rule also requires that telehealth services cannot act as a substitute for home visits that are ordered as part of the plan of care, nor can they be considered home visits for the purposes of patient eligibility or payment.
Therefore, HHS OIG plans to evaluate the home health services provided by agencies during the public health emergency to determine first which types of skilled services were provided via telemedicine and then to find whether those services were properly administered and billed under Medicare requirements. Any services that are found to be billed improperly will be reported as overpayments and HHS OIG will make recommendations to CMS based on the results.
Conclusion
Providers and others participating in telehealth, especially because of the COVID-19 public health emergency, should ensure they have robust compliance programs in place to avoid any unwanted penalties from this new focus on telehealth oversight by HHS OIG.