A new study has found that as specialists have seen a substantial increase in telehealth adoption levels, levels of erroneous claims have climbed along the way. The study was conducted by Codoxo, which offers healthcare AI solutions to healthcare payers and agencies.
The Codoxo study found that among the 41% of provider specialties that showed statistically significant increases in telehealth adoption, up to 15% of the claims were non-compliant with CMS guidelines.
Codoxo’s report, which reviewed telehealth claims filed between September 2019 to July 2021, looks at multiple payers, including Medicare, Medicaid and commercial plans. The research found that initial tell health consumption shot up 154% at the beginning of the pandemic.
After hitting a peak in April 2020, telehealth use hit a new steady state at about 20 times higher than pre-COVID levels, according to the company’s analysis of anonymized health plan data. (Meanwhile, the report notes that McKinsey & Company expects telehealth revenue to hit $250 billion, up from $3 billion today.)
In analyzing the claims data, the report focused on the top 10 CPT/HCPCS codes linked with telehealth modifiers, even though these codes aren’t among the codes recommended by CMS for telehealth. they represent 58% of non-compliant codes found in the study. When another 10 commonly misused telehealth codes are added, they account for approximately 75% of all such misused codes, researchers found.
To prevent such code misuse from becoming a problem, Codexo recommends that healthcare organizations educate providers on the latest issues related to the miscoding of telehealth data. They suggest looking for solutions (like theirs, naturally) then after peer benchmarking, provider self-monitoring and outlier behavior identification.
At the moment, it’s not clear whether CMS is prepared to come down hard on the organizations that are handling telehealth-related codes incorrectly. Heaven knows the agency has enough to do tracking error rates and fraud among its database of traditional claims.
That being said, even if CMS and commercial payers aren’t imposing extra scrutiny on your telehealth claim just yet, it would be wise to make sure you’re not making systemic errors going forward. After all, CMS in particular, much like the IRS, has tremendous power and never forgets when it has something against you.
If you think it’s possible that you’ve made some serious errors in coding for telehealth to date, it would be wise to find them now and take steps to make good with CMS. Ask anyone who’s been audited by CMS. You definitely don’t want them to have to come after you.
