Throughout the first yr of the COVID-19 public well being emergency, Medicare improperly paid for $580 million of psychotherapy care, together with $348 million of telehealth companies, based on an audit by the Division of Well being and Human Providers’ Workplace of the Inspector Common.
The report, which estimated that Medicare paid for $1 billion of psychotherapy that yr, included greater than 13.5 million psychotherapy companies supplied from March 2020 by way of February 2021.
The company selected two stratified random samples of psychotherapy companies in the course of the interval, one group of 111 enrollee days for telehealth and one other pattern of 105 enrollee days for in-person care. In line with the OIG, an enrollee day consists of all declare traces for Medicare Half B psychotherapy with the identical service begin date for a selected enrollee.
For 128 of the 216 complete sampled enrollee days, suppliers did not meet Medicare necessities. For instance, in 60 sampled enrollee days, psychotherapy time wasn’t documented. In 43 enrollee days, remedy plans have been incomplete or lacking.
Medicare paid $35,560 for the 128 sampled enrollee days the place suppliers did not meet necessities. Primarily based on that pattern, the OIG estimated that suppliers acquired $580 million in improper funds of the $1 billion that Medicare paid for psychotherapy that yr.
“The deficiencies we recognized in our audit occurred as a result of CMS’s oversight was not ample to stop or detect funds for psychotherapy companies, together with telehealth companies, that didn’t meet Medicare necessities and steerage,” the audit’s authors wrote. “CMS’s oversight was partially affected by the unprecedented challenges of the PHE as a result of CMS’s focus was to make sure that Medicare enrollees had entry to healthcare.”
As well as, in 54 sampled enrollee days, suppliers didn’t meet Medicare documentation and billing steerage, like forgetting supplier signatures or not specifying whether or not companies have been telehealth or in-person care. Although these errors weren’t related to improper funds, OIG mentioned the data could also be helpful for CMS when contemplating future oversight mechanisms or coverage modifications.
THE LARGER TREND
The OIG famous that earlier audits carried out earlier than the pandemic had discovered excessive numbers of improper fee charges, and this report aimed to find out whether or not that continued in the course of the early days of the COVID-19 PHE.
The company advisable that CMS work with contractors to get well the $35,560 in improper funds from the pattern, implement system edits for psychotherapy companies to stop funds for improper billing, and add instructional companies for suppliers in order that they meet necessities.
“Prior audits of particular person suppliers’ psychotherapy companies had related deficiencies, which is proof that compliance with Medicare documentation necessities for psychotherapy companies was problematic earlier than the PHE,” the OIG wrote. “Now that CMS has reinstituted most program integrity measures, CMS and the MACs [Medicare Administrative Contractors] should take motion to ascertain ample oversight mechanisms (e.g., conducting medical critiques of psychotherapy companies and making suppliers conscious of instructional supplies on billing and documentation for these companies) to make sure that Medicare pays just for psychotherapy companies that meet Medicare necessities.”
