decisionhealth Newsletters, Part B News - 2023 Issue 5 (May)
OIG issues audit guidelines for telehealth risk
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Article Overview
This article summarizes an OIG toolkit for reviewing telehealth claims and spotting elevated program integrity risk patterns. It is relevant to compliance teams, auditors, billing staff, and payers who oversee telehealth billing during the COVID-19 public health emergency, and it outlines the general types of risk indicators OIG says may be useful in claims analysis.
Why This Topic Matters
Telehealth utilization increased dramatically during the pandemic, and the article highlights how OIG is framing audit-focused analysis of telehealth billing patterns for Medicare and other payers. Readers can use it to understand the scope of the toolkit and the broad categories of billing behavior OIG considers higher risk without relying on the full report.
What You Will Learn
- What the OIG telehealth claims toolkit is intended to support
- Why telehealth billing drew program integrity attention during the pandemic
- The broad categories of telehealth billing patterns discussed in the audit guidance
- Who may use the toolkit for claims review and oversight
Who Should Read This
- Compliance officers
- Medical billing professionals
- Internal auditors
- Payer program integrity teams
- Healthcare administrators
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