E/M Coding Alert - 2020 Issue 9
Compliance: Double-Check Your Telehealth Claims for These Essential Details
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Article Overview
This article discusses telehealth compliance in the context of renewed Medicare review activity and highlights common documentation and claim-representation concerns seen in medical practices. It is aimed at providers, coders, compliance staff, and auditors who need a general understanding of telehealth claim risk, documentation expectations, and the types of telehealth services being scrutinized.
Why This Topic Matters
Telehealth utilization expanded rapidly, and the article explains that this growth is drawing greater audit attention. Understanding the scope of the article helps practices assess whether their documentation and billing processes are prepared for retrospective review.
Article Sections
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EDs may face audits in the very near future
Introduces the expected increase in medical review activity and the need for practices to pay close attention to telehealth claim documentation. It frames the article around compliance readiness and audit exposure.
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Past Audits Suggest Telehealth Errors Are Rampant
Summarizes prior audit findings and the broader concern that telehealth claims have frequently been documented incorrectly. The section provides context for why telehealth services are a likely review focus.
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Confusion Reigns in Medical Practices
Addresses documentation uncertainty around telehealth encounter formats and the distinction between different service types. It also discusses the importance of making the encounter method clear in the record.
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Ensure That Documentation Reflects Reality
Focuses on documenting what was actually performed during a telehealth encounter and recognizing the limits of remote assessment. It emphasizes consistency between clinical reality and the note.
What You Will Learn
- Why telehealth claims may be subject to increased audit scrutiny
- What kinds of documentation issues commonly appear in telehealth records
- How practices can think about distinguishing different telehealth encounter formats
- Why the accuracy of the medical record matters for remote services
- What general documentation considerations arise when physical assessment is limited by technology
Who Should Read This
- Physicians
- Emergency department clinicians
- Medical coders
- Compliance staff
- Practice managers
- Auditors
Codes Discussed
Code Ranges Discussed
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