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Texas Telemedicine Services Were Provided in Accordance with State Requirements

Why OIG Did This Audit

Medicaid telemedicine services are health services delivered via telecommunication systems. A Medicaid patient located at a patient site uses audio and video equipment to communicate with a physician or licensed practitioner located at a distant site. Medicaid views telemedicine services as a cost-effective alternative to the more traditional face-to-face way of providing medical care.

Medicaid programs have recently demonstrated increased interest in telemedicine services. This audit is one in a series of audits to determine whether selected States complied with Federal and State requirements when claiming Federal reimbursement for telemedicine services.

Our objective was to determine whether Telemedicine services were allowable in accordance with the Texas Medicaid requirements. Specifically, we reviewed whether these services met the technology, patient and provider location, and documentation requirements

How OIG Did This Audit

Our audit covered Medicaid telemedicine payments totaling $2.5 million ($1.4 million Federal share) made by Texas for services provided in 2015 and 2016. This was the most recent data available at the time we initiated our audit. We selected a judgmental sample of 40 client dates of service for review, totaling $2,836 ($1,661 Federal share).

What OIG Found

We determined that 39 of the 40 client dates of service we reviewed were allowable in accordance with the Texas Medicaid requirements. For the remaining client date of service, the provider submitted a claim for a professional service with the telemedicine modifier, however, we determined that it was a face to face visit and not a telemedicine service. This incorrect billing did not affect the Medicaid payment amount that the provider received.

What OIG Recommends and Texas Comments

This report contains no recommendations.

In written comments on our draft report, Texas agreed with our report and stated it had addressed the one compliance issue.

Filed under: Centers for Medicare and Medicaid Services