In early September, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released a report detailing that Medicare beneficiaries used 88 times more telehealth services during the pandemic’s first year than in the prior year.
The report recognized the importance of telehealth services, but also recognized the ongoing challenge in confirming these services are legitimate and provided in accordance with Medicare’s requirements. The OIG urged the Centers for Medicare and Medicaid Services (CMS) to conduct targeted oversight of the telehealth services.
To identify providers whose billing for telehealth services poses a high risk to Medicare, the OIG developed the following seven measures for CMS to scrutinize billing for:
- Both a telemedicine service and a facility fee for most visits;
- Telehealth services at the highest, most expensive level every time;
- Telehealth services for a high number of days in a year;
- Both Medicare fee-for-service and a Medicare Advantage plan for the same service for a high proportion of services;
- A high number of hours of telehealth services per visit;
- Telehealth services for a high number of beneficiaries; and
- A telehealth service and ordering medical equipment for a high proportion of beneficiaries.
A companion report also issued by the OIG analyzed the demographics of beneficiaries most likely to use telehealth and emphasized the important role telehealth played in Medicare beneficiaries’ access to care.
The companion report noted that unless policymakers take action, millions of beneficiaries will lose access to many telehealth services once the pandemic ends and the temporary exemptions to Medicare’s telehealth requirements terminate.
Related Posts
Biden-Harris Administration Releases Playbook to Address Social Determinants of Health (SDOH)
A growing body of evidence demonstrates the connection between health outcomes to income, education, nutrition, housing, environmental exposures, and other social circumstances. Similarly, studies have shown that interventions addressing SDOH can improve health outcomes and reduce health care costs. In response, the Biden-Harris Administration has released a playbook outlining new or strengthened initiatives that agencies…
Free Hearing Aids from Cochlear Implant Manufacturer May Violate Fraud and Abuse Laws
The U.S. Department of Health and Human Services Office of Inspector General (OIG) posted on October 25, 2023 Advisory Opinion No. 23-08, in which OIG rejected a proposed arrangement from a cochlear implant device manufacturer (the requestor) that would provide a free hearing aid to certain qualified patients who received a cochlear implant. OIG concluded the…
Representatives Bilirakis and Cartwright Introduce the Medicare Audiology Access Improvement Act of 2023 (H.R. 6445)
On November 17, 2023, Representative Gus Bilirakis (R-FL) and Matt Cartwright (D-PA) introduced the Medicare Audiology Access improvement Act (H.R. 6445). This legislation is also co-sponsored by Representatives Johnson (R-OH), Shakowsky (D-IL), Mace (R-SC), Blunt Rochester (D-DE), Fitzpatrick (R-PA), Trone (D-MD), Webster (R-FL), Cohen (D-TN), LaMalfa (R-CA), Grijalva (D-AZ), Foster (D-IL) and Pocan (D-WI). Senators Elizabeth…