Audio-Only Telehealth Visits During Pandemic Draw GAO Scrutiny

The federal oversight agency recommends CMS adopt new coding procedures to compare care quality to in-person visits.

With pandemic-fueled temporary waivers on telehealth leading to a surge in telehealth visits in 2020, especially on audio-only platforms, the practice is overdue for its own exam for effectiveness and privacy, according to a new Government Accounting Office (GAO) report.

The use of telehealth services topped 53 million visits in the period between April and December 2020. During the same period in 2019, only 5 million such visits occurred. Many of those were conducted by phone or non-video telehealth, which was rarely allowed prior to the pandemic.

[See also: CMS Proposes to Cut Audio_only Telehealth Coverage.]

The Centers for Medicare & Medicaid Services has monitored some risks to program integrity related to these telehealth waivers, but the GAO report found that CMS "lacks complete data on the use of audio-only technology and telehealth visits furnished in beneficiaries' homes," in part because no billing mechanism exists to identify all these telehealth visits.

"Providers are not required to use available codes to identify all instances of audio-only visits," the GAO reported. "Moreover, providers are not required to use available codes to identify visits furnished in beneficiaries' homes."

The GAO said this coding is important to monitor the quality of these telehealth services as compared to equivalent in-person services.

"CMS has not comprehensively assessed the quality of telehealth services delivered under the waivers and has no plans to do so, which is inconsistent with CMS' quality strategy," the GAO said. "Without an assessment of the quality of telehealth services, CMS may not be able to fully ensure that services lead to improved health outcomes."

The GAO offered three recommendations for CMS going forward:

1. Develop a new billing modifier or make clearer how to bill audio-only office visits for better tracking;
2. Require providers to use existing site of service codes when beneficiaries receive Medicare telehealth services at home; and
3. Assess the quality of telehealth services delivered during the public health emergency.

Finally, the GAO urged the Health and Human Services Department's Office of Civil Rights to offer additional education, outreach, and other resources to providers to help them explain risks to privacy and security that patients may face during telehealth visits.