COVID-19 Pandemic: Dealing with Emergency Waivers, Provider Relief Funding, and Potential Audits

Telemedicine and Telehealth Services

The COVID-19 pandemic has vastly accelerated the use of telehealth. This particular area of healthcare is extraordinarily ripe for audit activity due to the sharp increase in its use and the potential for errors in coding and billing applied to the wide range of new services and waivers, and also for differences in government and commercial payer coverage and reimbursement. The primary changes in public health emergency telemedicine include:

• State and CMS waivers that permit interstate practice and additional types of authorized providers;
• HIPAA enforcement discretion for use of certain non-public-facing audio or video communication products;
• DEA waiver of in-person evaluation for remote prescribing of certain controlled substances;
• OIG flexibility for providers to reduce or waive beneficiary cost sharing;
• CMS flexibilities allowing both provider and patient remote or at-home service locations;
• CMS flexibility to allow audio-only services;
• CMS waivers extending many services to new patients; and
• CMS waivers increasing reimbursement for virtual patient visits.

Providers should anticipate rigorous review of telemedicine services at the state and federal levels. OIG noted in June and July 2020 that it intends to review Medicare and Medicaid telehealth activity and reimbursement during the COVID-19 public health emergency. The OIG isn’t alone in its interest in suspected telehealth fraud and abuse; CMS and other federal and state agencies will likely engage in audits.

Best Practices: Providers who used or increased telemedicine and telehealth services during the public health emergency should consider conducting internal and external compliance checks for specific billing and coding practices, developing or enhancing compliance programs and policies for continued virtual service documentation, and requiring training or updated policy review for clinicians and coding staff prior to submitting future claims.

Steven M. Harris, Esq., is a nationally recognized healthcare attorney with McDonald Hopkins LLC. Contact him at sharris@mcdonaldhopkins.com.

Reprinted with permission from the American College of Rheumatology.