Telehealth spotlight and post-pandemic Medicare audits

Over the past several weeks, we have seen unprecedented changes to rules, edits, and other measures traditionally put in place to stave fraud, waste, and abuse in the healthcare industry. The changes happen so fast and so often with Telehealth services, I could be presenting a Webinar one day, and within hours it can be considered dated with new changes and direction from CMS.

Also, the floodgates have been opened when it comes to the Telehealth services, not only on what is considered Telehealth but the expanded rules on who are the approved qualified providers.

I have always believed that there was a place for Telehealth before COVID-19 and tried to encourage practices to open their minds to the concept, at least for established patients. Now the rules from the Medicare perspective were a bit behind the technology curve and were very limited in their reimbursement policies. But since the PHE (Public Health Emergency) was declared, physicians and other healthcare providers have been thrown into the telehealth fire, and it has been mandatory for them to engage in this delivery of services to stay solvent.

Unfortunately, each week, we see another iteration of the rules being changed. The most current iteration involves the allowance of telemedicine and telehealth by nearly any practitioner, including physical therapy, occupational therapy, and speech and language therapy. At some point, however, the continued relaxing of rules will undoubtedly become permanent rules to some extent. I do expect some rollbacks of course, but without having a crystal ball, I firmly believe that it is more difficult to take something away after it has been given than to give something that was not previously available.

Now in saying that, and being an auditor, the Evaluation and Management services have always been an easy target for CMS to use for audit target practice and there has to be a fraud and abuse line drawn at some point, because of all of the money being paid for telehealth services. Also, where is that line on what can “really” be delivered digitally? When I start getting calls (and I have) from Acupuncturists asking how they can tap into the telehealth delivery, I had to throw the question back, Where is the line that gets drawn on the use of this technology? Can acupuncture services, physical therapy, and/or occupational therapy truly exist in a virtual environment? I do not know the answer, but there are certainly treatment modalities that require that special “hands-on” that only comes from true face to face care, and having a parent or patient friend in the background as the acting agent for the on-the-phone provider seems a bit suspect to me. Just as a dentist is not able to perform a procedure in a virtual environment, there has to be a limitation placed on how telemedicine and telehealth are really implemented.

In a recent blog post, on, I read a discussion that the author had with someone, and there was an analogy made between taking a virtual yoga class via a social media platform and having a physical therapist oversee exercises in the home. Their main contention was that physical therapists can take empirical measurements, make hands-on corrections, and take action with the patient to ensure that the patient is making progress. Keep in mind that Medicare is very specific regarding the circumstances under which it will pay for such therapies. Please understand that I am by no means taking issue, per se, with physical, occupational, or speech therapy modalities. But I agree with that blog post, in that, each instance where telemedicine and telehealth are expanded to peripheral treatment regiments really will have additional collateral consequences.

My main concern is when audits start flooding in. A contact of mine, on a popular business social medial platform, who is also a retired HHS fraud investigator, recently wrote an article on the “when” audits return, not “if”. Mr. Rubenstein wrote, “Evaluation and Management audits have always been on payers’ radars, and the future telemedicine audits are going to be no different. Big money is being paid out, and big money will be sought for poor documentation.” I invite you to read his article; it will change your mindset on compliance and make sure that you are doing things right from the get-go.

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