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OIG Expands Telehealth, Telemedicine Audits to Medicaid Claims

Following a July announcement to audit Medicare Part B payments, the OIG has announced a similar analysis of telemedicine and telehealth claims under Medicaid.

Source: ThinkStock

By Eric Wicklund

- Healthcare providers will be checking to make sure their telehealth and telemedicine programs comply with state Medicaid regulations following news that the Health and Human Services Department’s Office of the Inspector General will be launching an audit.

The OIG made the announcement this week that it would be reviewing state Medicaid payments for telemedicine and other remote services to confirm that providers are billing properly for digital health reimbursements.

The audit is due to be completed in 2019.

“Medicaid pays for telemedicine, telehealth, and telemonitoring services delivered through a range of interactive video, audio or data transmission (telecommunications),” the OIG announced. “Medicaid programs are seeing a significant increase in claims for these services and expect this trend to continue. We will determine whether selected States' Medicaid payments for services delivered using telecommunication systems were allowable in accord with Medicaid requirements.”

Nathaniel Lacktman, an attorney with the Foley & Lardner law firm and chairman of its Telemedicine Industry Team and co-chair of its Digital Health Work Group, said providers shouldn’t fear the audit or use it as an excuse to put off new programs.

“Indeed, the project and its eventual report can help shed light on those areas of compliance which the OIG believes important,” he wrote in a recent blog. “In the interim, providers should continue to ensure their telehealth programs and claims comply with state Medicaid requirements, including coverage, coding and documentation rules.”

The OIG announced a similar audit in July for Medicare Part B programs, focusing on whether providers are launching telehealth programs from an approved originating site. That audit is due to be completed in 2018.

The two audits were based on a surge in reimbursement requests for telehealth and telemedicine services, and offer evidence that healthcare is adopting digital health platforms at an increasing pace.  

Earlier this year, an analysis of the Centers for Medicare & Medicaid Services’ 2016 payments found that CMS paid out $28,748,210 in telehealth and telemedicine claims, up 28 percent over the $22,449,968 shelled out in 2015. The number of claims, meanwhile, rose 33 percent, from 372,518 to 496,396. Last year, Medicare payments for telehealth and telemedicine increased by 25 percent over 2015, while the total number of claims jumped 27 percent.


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