By Eric Wicklund

Jan 25, 2021 – Health systems and home health authorities that have expanded their telemedicine footprint to provide home health services during the coronavirus pandemic may soon be scrutinized by the federal government.

The Office of the Inspector General of the Department of Health and Human Services started an audit of home health services provided through connected health during the COVID-19 public health emergency to verify that providers are doing more than they are supposed to do to be eligible for reimbursement.

The probe targets the confusing and often criticized guidelines for Medicare coverage. Providers have long complained that the Centers for Medicare & Medicaid Services offer little reimbursement for telemedicine services, and while CMS has expanded that coverage through Section 1135 waivers during the PHE, they do not address the challenges providers are currently facing the provision of care.

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“Telemedicine has been around in home health for a long time – at least a few decades,” said William Dombi, president of the National Association for Home Care and Hospice (NAHC). said mHealthIntelligence in an interview in July 2020. “But it didn’t work well from a business perspective.”

Home health providers are looking for more leeway from CMS to leverage telemedicine and bill Medicare for these services. Specifically, they want CMS to simplify the rules that allow most reimbursements to be made by the primary care provider who can prescribe and administer telemedicine services in the home health area. They would also like to see more home health providers, including those focused on therapy and rehabilitation services, reimbursed for their use of telemedicine.

These rules have been relaxed somewhat to allow home health care providers to use telemedicine during the pandemic. Under the amended terms, CMS now allows home health care providers to use some telemedicine tools in conjunction with in-person visits, as long as the technology is related to the services provided, is included in the care plan, and does not replace in-person visits.

Now the OIG wants to make sure that these guidelines are followed.

“We will be evaluating the home health services provided by the agencies in the public health area during the COVID-19 emergency to determine what types of qualified services were provided through telemedicine and whether those services were managed and billed in accordance with Medicare requirements were noted, “said the agency in its report. “We will report any services that have not been properly billed (and) as overpayments and make recommendations to CMS based on the results of our review.”

The review is expected to be completed in the next year.