Telehealth Volume Grows Throughout Pandemic but Claims Error Levels Climb Too

A new study has found that as specialists have seen a substantial increase in telehealth adoption levels, levels of erroneous claims have climbed along the way. The study was conducted by Codoxo, which offers healthcare AI solutions to healthcare payers and agencies. The Codoxo study found that among the 41% of provider specialties that showed statistically significant increases in telehealth adoption, up to 15% of the claims were non-compliant with CMS guidelines.

Codoxo’s report, which reviewed telehealth claims filed between September 2019 to July 2021, looks at multiple payers, including Medicare, Medicaid and commercial plans. The research found that initial tell health consumption shot up 154% at the beginning of the pandemic. In analyzing the claims data, the report focused on the top 10 CPT/HCPCS codes linked with telehealth modifiers, even though these codes aren’t among the codes recommended by CMS for telehealth. they represent 58% of non-compliant codes found in the study. When another 10 commonly misused telehealth codes are added, they account for approximately 75% of all such misused codes, researchers found.

To prevent such code misuse from becoming a problem, Codexo recommends that healthcare organizations educate providers on the latest issues related to the miscoding of telehealth data.  They suggest looking for solutions (like theirs, naturally) then after peer benchmarking, provider self-monitoring and outlier behavior identification.