COMING SOON TO YOUR PRACTICE: OIG TELEHEALTH SERVICES AUDITS
2020 brought many changes very quickly across healthcare, most notably in the use of telehealth technology. Many providers rapidly expanded on their existing telehealth services, or hastily implemented new (and perhaps informal) telehealth solutions, to adapt to the evolving circumstances. However, as we approach the one-year anniversary of the Covid PHE, the OIG appears to be signaling not only that it believes telehealth is here to stay, but also that telehealth billing compliance will be a key focus area. In January, the OIG amended its 2021 work-plan to include audits of Medicare Part B and home health telehealth services.
Throughout 2020, telehealth played an important role in facilitating care for patients who were unable or unwilling to travel to a health care facility for in-person services. CMS responded by extending numerous flexibilities for telehealth services ─ some of which were made permanent under the 2021 Physician Fee Schedule Final Rule (see below). As CMS explores how telehealth services can be expanded beyond the PHE, OIG will have its auditors in the trenches evaluating whether telehealth services were administered and billed in accordance with Medicare requirements. These audits will likely result in recommendations to CMS for further changes to telehealth rules aimed at promoting the twin goals of encouraging effective and efficient use of telehealth services, while at the same time reducing fraud, waste, and abuse.
THE 2021 TELEHEALTH LANDSCAPE AT A GLANCE
Permanent (and More Temporary) Changes for 2021
In the 2021 Physician Fee Schedule Final Rule (Final Rule), CMS made permanent some of the telehealth changes that were implemented in 2020. At the same time, CMS extended certain flexibilities through 2021 or the end of the PHE, while declining to make them truly permanent. [JR1] Several highlights of the Final Rule include:
Permanent Addition of New Codes – CMS has permanently added the following codes to the telehealth-eligible services:
Group Psychotherapy (CPT 90853)
Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT 99334-99335)
Home Visits, Established Patient (CPT 99347- 99348)
Cognitive Assessment and Care Planning Services (CPT 99483)
Visit Complexity Inherent to Certain Office/Outpatient E/Ms (HCPCS G2211)
Prolonged Services (HCPCS G2212)
Psychological and Neuropsychological Testing (CPT 96121)
2. Temporary Addition of New Codes – CMS finalized its new “Category 3” basis to describe those services that are temporarily added to the Medicare telehealth list through the later of the end of the year in which the PHE ends or December 31, 2021 and has added codes that will be available in this Category.
3. Permanent Decrease in Frequency Limitations for Subsequent SNF Visits - CMS finalized a policy to allow subsequent nursing visits to be furnished via telehealth once every 14 days in a SNF. This is a deviation from the “once every 3 day” limit CMS had put forth in the proposed rule based on the agency’s efforts to “find the right balance” between the desire to increase access to care through telehealth and concerns about creating a “disincentive for in-person care.”
4. Continued (Temporary) Direct Supervision Via Audio/Video Technology – Until December 31, 2021, or the end of the PHE (whichever is later), CMS finalized its proposed clarification that “direct supervision” may be provided using real-time, interactive audio and video technology (audio-only is not permitted). This applies to many “incident-to” services as well as certain diagnostic services paid under the Physician Fee Schedule. As an interim final policy during the PHE, CMS revised the definition of direct supervision to include virtual presence of the supervising physician or practitioner using interactive audio/video real-time communications technology. The Final Rule finalizes this policy temporarily, as CMS declined to make this change truly permanent, citing patient safety and program integrity concerns. However, CMS has indicated it will consider to what degree and on what basis this flexibility could be continued following the PHE.
OIG TELEHEALTH AUDIT PLAN
The 2021 Work Plan outlines a two-phase series of audits of Medicare Part B telehealth services to determine whether Medicare requirements were met.
· Phase one audits will focus on certain service types, such as evaluation and management, opioid use order, end-stage renal disease, and psychotherapy.
· Phase two audits will include additional audits related to distant and originating site locations, virtual check-in services, electronic visits, remote patient monitoring, use of telehealth technology, and annual wellness. The report for this audit is expected to be issued in Fiscal Year 2021.
As with all OIG audits, any services deemed to be improperly billed will be reported as overpayments.
Impact to Providers
Given the dynamic nature of the telehealth landscape, and the uncertainty inherent in operating under flexibilities that may expire and rules that may change, providers face some unique compliance challenges. Nonetheless, compliance with the telehealth requirements is an audit priority for the OIG and consequently should also be a priority for practices.
Now is the perfect time for providers to examine how they currently use telehealth technology and how that use may change/expand in the future. A thorough review needs to include updates to compliance programs, policies and procedures as well as updates to staff education around compliant performance, documentation and billing for these services.
And, of course, self-auditing of telehealth service claims is a key component of this compliance review. Are your providers documenting properly, are your diagnosis codes accurate, are your charges on target? The results of a well-done self-audit provide the tools needed to identify weaknesses and strengths and build the framework for an effective compliance program.
When it comes to telehealth, the agile way healthcare pivoted to embrace technology and meet patient care demands is among the more dramatic and positive changes that 2020 brought for providers and patients. This year, providers should continue to follow developments in this rapidly evolving space, paying attention to what changes are here to stay, which will expire, and which may ultimately be made permanent.
The full OIG Work Plan
Work Plan | Office of Inspector General | U.S. Department of Health and Human Services (hhs.gov)
The telehealth workplan:
Audits of Medicare Part B Telehealth Services During the COVID-19 Public Health Emergency (hhs.gov)
For information about how MRS can support your self-audit endeavors, read more here: www.mrsnh.com