Any specific medical field can see a few reimbursement hiccups from time to time, and telehealth is no exception. According to a recent analysis from the Office of Inspector General (OIG), telehealth overpayment was far from uncommon in recent years. In fact, a sample of claims reimbursed by the Center for Medicare and Medicaid Services (CMS) during 2014 and 2015 shows that over half of these claims were overpaid.
Though this may seem alarming at first glance, it is important to note how much telehealth has grown in a short period of time. CMS reported $17.6 in telehealth reimbursement from 2015, up from the meager $61,000 back in 2001. As a result, many organizations felt it was time to take action into investigating the reimbursement process. After analyzing 191,118 relevant claims, OIG took a random sampling of 100 to determine the cause of the telehealth overpayments. Of these samples, 31 did not meet proper requirements. Of this 31 erroneous claims, 24 simply didn’t meet the criteria of originating from a non-rural location. From there, seven of the claims were submitted by institutions who were not eligible for telehealth reimbursement at all. Several others cases involved unauthorized originating sites, improper means of telecommunication, and non-covered services.
In response, OIG recommended that CMS implement new rules and work with its contractors to ensure accurate reimbursement in the future, advise that CMS is sure to take to heart. While this error has been working in practices’ favor, be warned that it will not last forever. As virtual healthcare becomes more commonplace and Medicare begins to crack down, telehealth overpayment will become less and less common. As a result, it is imperative to make sure your claims are fully backed up with proper documentation and correct codes, and that they are always submitted on time and in full.