Expanding telehealth provisions bring escalating compliance risk

Behavioral healthcare providers who bill Medicare will continue to see significant changes in telehealth as they implement new provisions allowed under the Medicare Physician Fee Schedule (MPFS) Final Rule for CY 2024.

New telehealth billing codes became effective on Jan. 1 of this year, and definitions of telehealth practitioners expanded at the same time. Mental health counselors and marriage and family therapists are now allowed to bill as distant site practitioners for the purpose of providing telehealth services.

Download our Checklist of New Telehealth Provisions for 2024 here

As Medicare continues to embrace and expand the practice of telehealth, associated compliance risks for behavioral healthcare providers are escalating.

In addition to cybersecurity and HIPAA compliance concerns related to telehealth, there are thorny new issues about practicing across state lines, because state licensure and scope of practice laws are far from uniform, varying greatly from state to state. 

All eyes on telehealth

The Centers for Medicare and Medicaid Services (CMS) is not the only agency carefully scrutinizing telehealth. Many other watchdogs are also weighing the risks and benefits of these emerging modalities, including:

  • The Federal Trade Commission (FTC). Healthcare and technology are two heavily targeted industries, and from the FTC perspective, the practice of telehealth has opened a new frontier of antitrust legal issues which must be monitored and evaluated.
  • The U.S. Department of Justice. The Justice Department continues to aggressively investigate fraud, waste, and abuse, often teaming up with other federal and state law enforcement teams, including the Health Care Fraud Strike Force, for nationwide enforcement action.
  • The U.S. Department of Health and Human Services Office of Inspector General (OIG). The OIG continues to focus on telehealth services it considers to be high risk, and in 2023 issued detailed information designed to help healthcare providers analyze telehealth claims to assess federal healthcare program integrity risks.

Areas of program integrity risk

The OIG studied the use of widespread telehealth across selected healthcare programs during the COVID-19 pandemic, and identified several Medicare program integrity risks associated with billing for telehealth services.

Areas of specific risk identified by the OIG include:

  • Inappropriate billing for the highest, most expensive level of telehealth services
  • Duplicate claims
  • High-volume billing

Additional telehealth safeguards

The study prompted the OIG to identify the need for these telehealth safeguards:

  • Additional monitoring of telehealth services.
  • Stronger billing controls to prevent inappropriate payments for telehealth services.
  • Efforts to educate providers and individuals about telehealth services.
  • Collection of additional data related to telehealth services.
  • Collection and review of information on the impact of telehealth services on quality of care

How SimiTree can help

Regulations related to the delivery of healthcare services via telehealth continue to evolve rapidly.  SimiTree works with providers across healthcare settings to ensure billing compliance, reducing healthcare program integrity risks.

Our compliance team is made up of former auditors and Medicare methodology experts who fully understand the medical review process, have experience in implementation of billing controls, and stay abreast of all regulatory changes.

Here are a few other ways our experienced healthcare team can help:

  • Our HIPAA Privacy Assessment can help providers serving patients through everyday communications technologies ensure that all standards of the HIPAA Privacy and Security Rules are met.
  • New to Medicare billing? Our knowledgeable consultants can help with Medicare enrollment for mental health counselors and marriage and family therapists, and set up effective billing controls to avoid improper practices and insulate your organization from audit risk.
  • Maintain compliance with accurate documentation and billing practices. Our certified healthcare compliance experts can review clinical documentation to identify areas of risk and provide the training needed to help your organization mitigate risk.

Reach out to us today and let’s work together to shore up your organization’s telehealth compliance.

Next week: The OIG says these telehealth numbers are red flags

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Have a compliance question?

SimiTree’s certified healthcare experts can help! Our team is made up of former auditors and surveyors from across healthcare settings. We have the know-how and the experience to help your organization mitigate risk. Contact us today with all your compliance needs.

J’non Griffin serves as Senior Vice President for the Compliance as well as Coding divisions at SimiTree. With a healthcare career that spans three decades, she has a track record of helping many provider types implement effective compliance programs. She has worked with organizations nationwide  to develop compliant emergency preparedness and operation plans, implement fully compliant plans of care, and meet regulatory demands. As an AHIMA ambassador, Griffin was instrumental in preparing the coding community for the launch of ICD-10.