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Discrepancies in Audio-Only Telemedicine Data May Affect Future Reimbursement Policy


July 28, 2022 | Reading Time: 3 Minutes

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In March 2020, Medicare started reimbursing video and audio-only telehealth visits at the same rate as in-person consultations, responding to the public health emergency (PHE). While the Centers for Medicare and Medicaid Services (CMS) has permanently approved reimbursement for audio-only behavioral care, the future of reimbursement for other types of audio-only telemedicine in other healthcare disorders is still being evaluated by CMS. Practitioners working with reimbursement models defined by third-party carriers may also want to be aware of the research supporting arguments for and against extending audio-only reimbursement beyond the PHE.

Continuing vs. Discontinuing Reimbursement for Audio-Only Telemedicine

Proponents of continuing reimbursement for the general medical policy argue that audio-only telemedicine represents an essential service, particularly for those who don’t have access to digital systems like video. Those arguing against the continuation of the policy point out that audio-only telehealth visits are often of poor quality, overused, and more prone to abuse and fraud.

Policymakers would generally settle such disagreements by referring to the data. However, according to a recent report published by Health Affairs, Audio-Only Telemedicine Visits: Flaws In The Underlying Data Make It Hard To Assess Their Use And Impact, there appear to be data discrepancies relating to audio-only telehealth visits.

Data Discrepancies Found in Audio Only Telehealth Visits

The research author, Ruth Hailu and colleagues, used three data sources to quantify telemedicine use: claims, electronic health records (EHR), and surveys. According to the claim-based studies, audio-only telehealth visits made up 25% of billed sessions, the survey-based studies reported 50%, and EHR records 55%. The authors concede that some of these differences could relate to population and clinical settings variances, but this is not the complete picture.

To better understand the difference in data, the researchers examined a 2020 Medicare survey. They found audio-only claims for just 20% of the people who claimed they had participated in audio-only visits. The rest were claimed as video consultations. The study’s authors suggest that the clinicians who submitted the claims may have miscoded the audio-only telehealth visits as video visits for the following reasons:

  • Accurate coding may not have seemed important.
  • Lack of financial support to use audio-only codes, given the similar reimbursement rates for audio and video.
  • EHR and other billing software might have prevented using audio-only visit codes.
  • Provider confusion about the differences required for billing one or the other type of code.

The report also mentions two forms of inaccurate reporting: 1) clinicians may not have billed clients who phoned with a quick question, but the patient may have reported this as an audio-only telehealth visit and 2) over-reporting by patients.

How Important is Audio Only Telemedicine?

Recognizing these data discrepancies between billing records and patient reports, researchers in the above-mentioned study believe the fraction of audio-only telemedicine is higher than reported in claims—but how much higher is unknown. Audio-only telemedicine allows patients to access health care despite not having the digital knowledge or the means to make video calls. In conclusion, the study’s author suggested a few things that could make things easier for everyone involved. Some of the suggestions are below:

  • Collecting better data to help improve the quality of claims data.
  • Payers should simplify coding for audio-only telemedicine visits vs video visits.
  • Policymakers and system leaders should prioritize training healthcare providers and coders on telemedicine coding and related documentation.
  • Adaptations of EHRs and related billing systems to increase accuracy.
  • Funders can work with health systems or delivery settings to improve and standardize reporting of audio-only telehealth visits for evaluation.

The resulting data could then be used to study these visits’ use, quality, and equitable distribution. The study’s researchers also suggest that policymakers should be careful when using current data to assess the role of audio-only telemedicine. A November 2021 survey published in the Journal of General Internal Medicine found that rural, older, and black people were more likely to use audio-only telemedicine. In March, a RAND Corporation report highlighted the importance of audio-only telehealth as a safety net, especially for behavioral health. Still, the Centers for Medicare and Medicaid Services (CMS) plans to discontinue audio-only telemedicine coverage, according to the CMS proposal for the 2023 Medicare Physician Fee Schedule.

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