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Commercial Payer, Medicare Telehealth Audits Are Underway, With Some Surprises

In an audit twist that shows the prevalence of telehealth services because of COVID-19, some reviews are underway of in-person home infusion, with auditors questioning why home infusion physician practices aren’t delivering more follow-up services by telehealth, an attorney said.

“There’s a lot of scrutiny of how complex home infusion services are provided,” said attorney Stephen Bittinger, with K&L Gates in Washington, D.C. “I have seen a significant uptick.” Pandemic lockdowns in geographic areas played a role in an auditor’s skepticism about the number of in-person visits to infusion patients. From the auditor’s perspective, the nurses could use telehealth for lower-cost follow-up visits in between infusions. “Reviewers are going to be examining the context of delivery of services and questioning why providers weren’t choosing less expensive telehealth options,” Bittinger said. In this case, the auditor works for a commercial payer.

That is one type of telehealth audit underway, less than a year after audio-only and audiovisual visits became a lifeline—literally for patients and financially for providers, as COVID-19 cast its shadow across the country. Providers have been in uncharted territory. Medicare rapidly expanded coverage and accepts claims for telehealth services delivered to patients by providers in other states during the public health emergency (PHE) as long as they’re licensed in one state (although they’re still subject to state laws). As a result, there’s a lot of room for error.

“It’s going to be the most incredible wave of auditing we have ever seen,” Bittinger said. “It’s going to be wild for the next couple of years. There were so many shifts in who delivers services and changes in services.”

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