HHS OIG to Review Medicaid Telehealth Payments

Nov. 21, 2017
The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) plans to review Medicaid payments for telehealth services to gauge compliance with reimbursement requirements.

The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) plans to review Medicaid payments for telehealth services to gauge compliance with reimbursement requirements.

The OIG added the review to its work plan this week, noting that Medicaid pays for telemedicine, telehealth, and telemonitoring services delivered through a range of interactive video, audio or data transmission (telecommunications). And, OIG noted that Medicaid programs are “seeing a significant increase” in claims for telehealth and telemonitoring services and Medicaid programs 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,” OIG stated in its update.

The report is scheduled for 2019.

The agency previously announced another audit this past summer involving a review of Medicare payments for telehealth services.

Medicare Part B covers expenses for telehealth services on the telehealth list when those services are delivered via an interactive telecommunications system, provided certain conditions are met. OIG noted in that update in order to support rural access to care, Medicare pays for telehealth services provided through live, interactive videoconferencing between a beneficiary located at a rural originating site and a practitioner located at a distant site. An eligible originating site must be the practitioner's office or a specified medical facility, not a beneficiary's home or office.

OIG said it plans to review Medicare claims paid for telehealth services provided at distant sites that do not have corresponding claims from originating sites to determine whether those services met Medicare requirements. That report is scheduled to be issued in 2018.

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