Posted: December 13, 2021
At the start of the COVID-19 pandemic in early 2020, many healthcare providers turned to telehealth as means to provide their patients with care while eliminating any potential risk of exposure to illness. Providers continue to implement and expand telehealth services, as they’ve become an efficient and effective way to continue care. While implementing telehealth can be done relatively quickly, it is imperative to follow the correct procedures to make sure your practice is avoiding any potential compliance risk.
At the onset of the pandemic, the U.S. Department of Health and Human Services (HHS) and related agencies helped providers expedite telehealth implementation by relaxing restrictions and issuing waivers for certain stipulations related to telehealth delivery. While the increase in telehealth services since that time has largely been for the benefit of the community, there have been instances of providers taking advantage of the telehealth system.
In September 2020, the HHS Office of Inspector General (OIG) participated in a National Health Care Fraud Takedown that uncovered over $6 billion in fraudulent charges to federal health care programs. The OIG is continuing its focus on auditing provider compliance with telehealth requirements.
If your practice is considering implementing new telehealth programs, altering existing service lines, or entering into new arrangements with external telehealth services, it is important to review and consider five key factors to ensure compliance and protect your organization.
1. If telehealth implementation requires your organization to enter into a third-party agreement, including labs, pharmacies, and DME companies, clearly designate what each party will provide as part of the arrangement.
2. When creating marketing strategies for your telehealth services, be sure to confirm potential patients will be reached through the appropriate channels. Regulations prohibit “cold calling” potential patients to market your services.
3. Each state has its own laws and regulations regarding the establishment of a legitimate physician-patient relationship prior to telehealth services. Carefully evaluate the regulations in your state and understand which are permanent and which are temporary in light of COVID-19.
4. Review all marketing materials, compensation, and billing arrangements and address any issue arising from telehealth arrangements.
5. Carefully review coding and billing practices to ensure they are consistent with Medicare and commercial payor requirements. As the requirements have changed during COVID-19 and will likely continue to do so, it is important to conduct regular reviews.
In addition to these items, it is important to make sure all of your organization’s employees understand the regulations that must be followed and the proper channels for reporting any suspected misconduct. Regular staff training, employee newsletters, and memos can help provide refreshers to employees with the latest updates and information pertaining to compliance.
While the goal is to avoid compliance investigations, organizations with strong compliance programs are best positioned to promptly assess, respond, and react should an allegation arise. To find out how Let’s Talk Interactive can help your organization with telehealth compliance, contact us today.