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Medicare faces scrutiny for improper telehealth payments

04/18/2018 7:37 PM | Rebekah Francis (Administrator)

A new report from the U.S. Department of Health and Human Services Office of Inspector General (OIG) concluded that nearly one-third of claims did not meet Medicare requirements for telehealth services, resulting in improper payments of around $3.7 million in 2014-2015. Most sampled claims were deemed improper because patients were not located at a rural geographic originating site. OIG recommended the Centers for Medicare & Medicaid Services (CMS) conduct periodic post-payment reviews on telehealth claims, underscoring the importance of billing compliance, particularly with respect to originating site rules. MGMA recommends practices use the Medicare telehealth eligibility analyzer to determine payment eligibility based on location and urges groups who bill Medicare for telehealth services to ensure their claims comply with Medicare requirements.


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