After the results of a recent Office of Inspector General (OIG) audit were released back in April, many insurance providers made plans to crack down on telehealth claims. Telehealth claims have expanded exponentially in the past several years, with the amount of Medicare telemedicine reimbursement rising from $61,000 in 2001 to $17.6 million in 2015. After the recent announcement that the FCC is allocating significant funds to expand virtual health efforts in rural areas, many practices want to make sure they can identify major errors sooner rather than later.

According to OIG’s findings, a random 100 claim sampling yielded 67 problems, meaning that a full two-thirds of telehealth claims were billed incorrectly. Assuming this ratio persists on a larger scale, OIG estimates that Medicare doled out $3.7 million of improper payments in 2015 alone.

Of the 67 erroneous claims, AAPC breaks down the reason behind each problem below:

• 31 claims did not meet service requirements
• 24 claims were performed at non-rural sites
• 7 claims were provided by ineligible providers
• 3 claims were provided at unauthorized originating sites
• 1 claim was for a non-covered service
• 1 claim was for services provided by a physician located outside of the United States

Despite these errors coming from practices across the country, OIG placed much of the blame on the Centers for Medicare and Medicaid Services (CMS) for not employing proper checks and edits aimed at catching and correcting these problems. To ameliorate the issues, OIG recommended that CMS work to review sets of claims and educate practices about proper telehealth billing.

If you work for a practice or facility that sees a large number of virtual patients, be sure that you and your coworkers review the proper protocol for billing these telehealth claims. Insurance carriers are only planning to tighten their telemedicine scrutiny in the future, so reviewing the rules now can save valuable time and money down the line.