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What Medicare audits mean for your telehealth business

On Behalf of | May 14, 2018 | Medicare & Medicaid |

Telehealth represents an incredible step forward in medical technology. As a telehealth doctor, you represent the front line of healthcare for folks making their living in the rural parts of the country, and with that comes unique sets of challenges. More Texas-based telehealth providers than ever are being subjected to Medicare audits.

Medicare audits on the rise

It stands to reason that Medicare is auditing more aggressively. As the telehealth industry expands, so too will its regulation. In 2015 alone Medicare spent over $17.5 million dollars on telehealth payments, truly eclipsing the roughly $60,000 paid in 2001.

In this same year, The U.S. Department of Health & Human Services and the Office of Inspector General audited nearly 200,000 telehealth claims totaling $13.8 million paid for by Medicare. In a stratified random sample of 100 claims, over 30 percent were found to not meet Medicare’s requirements, totaling an estimated $3.7 million the company would not have needed to pay.

Of the ineligible claims, the majority wound up being rejected because the patient received services at nonrural originating sites. Several others were billed by ineligible providers, and others still were ineligible because the services were conducted with an unallowable means of communication.

If youre being audited

This, understandably, may be a frightening prospect. As a telehealth provider, your primary concern most often lies with helping your patient. Learning that you could face severe financial penalties or criminal charges because you misread your patient’s location or used the wrong teleconference app no doubt gives serious pause.

Medicare audits often come completely without warning. Most times you’ll be going about your practice, the same as any other day, when you’re suddenly blindsided by an auditor’s letter requesting additional documents. There are very few formal laws on this procedure, and it is largely unregulated, making it quite an intimidating situation.

You don’t have to go it alone if you’ve been contacted by an auditor. A skilled attorney is a key asset in these situations – they can advise you on the best practices and best strategies for dealing with Medicare. Whether you’re facing a full or partial audit, a lawyer will help you every step of the way.