Telehealth During 2020 Helped Ensure End-Stage Renal Disease Patients Received Care, But Limited Information Related to Telehealth Was Documented

Why OIG Did This Audit

In response to the COVID-19 public health emergency (PHE) and pursuant to section 1135 of the Social Security Act, the Secretary of Health and Human Services (HHS) authorized the Centers for Medicare & Medicaid Services (CMS) to temporarily implement waivers and modifications to Medicare program requirements, retroactive to March 2020. From March through December 2020 (audit period), Medicare claims data shows that payments for end-stage renal disease (ESRD)-related telehealth services increased almost 10,000 percent from 2019. Oversight of telehealth expansion is increasingly important to ensure that Medicare enrollees receive the appropriate care while protecting the program from fraud, waste, and abuse. We conducted this audit of ESRD-related telehealth services provided during the first year of the PHE to verify whether providers complied with Medicare requirements, determine what telehealth-related information was documented in the medical records, and further inform policymakers and other stakeholders as they consider permanent changes to telehealth policies.

Our objectives were to determine, for ESRD-related telehealth services provided during the PHE: (1) what information related to the telehealth services was documented in the medical records and (2) whether the claims met certain Medicare requirements.

How OIG Did This Audit

Our audit covered approximately $38 million in Medicare Part B payments for 179,952 ESRD-related telehealth services provided during our audit period. We selected a stratified random sample: one stratum included 75 claim lines for telehealth services provided to in-center dialysis patients, and the other included 25 claim lines for telehealth services provided to at-home dialysis patients.

What OIG Found

Providers documented limited information related to telehealth services in the medical records, but the ESRD-related telehealth service claim lines generally met certain Medicare requirements. Most medical records for sampled claim lines included documentation identifying that the service was provided via telehealth but did not include documentation that would allow us to determine whether the services were provided using 1) audiovisual interactive technology and 2) technology that was non-public-facing.

CMS does not oversee or enforce whether the telecommunications systems used to provide telehealth services are non-public-facing; the Health and Human Service's Office for Civil Rights (OCR) has responsibility for oversight of this requirement. Any information in this report regarding non-public-facing telecommunications systems used is for informational purposes only.

What OIG Recommends

Although we are not making any recommendations, we believe it would be beneficial for the medical records to document the type of telecommunications system used to perform the telehealth visit. This information may be beneficial to CMS and OCR when considering future oversight mechanisms or changes regarding remote communication products.

Because this report contains no recommendations, CMS did not provide written comments on our draft report but did provide technical comments, which we addressed as appropriate.