The Chicago Business Journal published an interesting piece in January 2022 outlining the supposed perils telemedicine brings to the healthcare industry. Those perils are related to potential healthcare fraud. Unfortunately, the piece seems to present telemedicine as some sort of digital bogeyman with some special power to promote healthcare fraud.
Telemedicine is here to stay thanks to changes ushered in by the COVID crisis. With that being the case, we must resist the temptation to blame telemedicine for fraud. Telemedicine is a tool. It cannot commit fraud on its own. To the extent that healthcare fraud might be easier to perpetrate via telemedicine, the solution is not to vilify telemedicine itself.
Telemedicine and Coding Errors
One of the potential complaints cited by the Chicago Business Journal piece is that “provider billing and coding errors” offer more opportunities for up-coding, the practice of substituting less lucrative healthcare services with more lucrative ones during the coding process.
If telemedicine offers more opportunities for doing so, it is only because relaxed Medicare rules offer more opportunities to see patients via telemedicine solutions. But that being the case, telemedicine is not responsible for the fraud. Those doing the actual coding are the ones committing the fraud. Telemedicine doesn’t make it any easier to do that.
The idea that visiting with patients via video conferencing opens the door wider to fraud than visiting in-person is absurd. The same coding specialist handles billing regardless of how a patient sees their doctor. The same holds true for complaints that healthcare providers can now bill for longer visits than are actually taking place via telemedicine.
Billing Is the Real Problem
Blaming telemedicine for alleged increase in healthcare fraud since the start of the coronavirus crisis is little more than a red herring. Once again, telemedicine is just a tool. The real culprit in all of this is the billing and coding system the healthcare industry operates under.
CSI Health is a San Antonio company that provides healthcare solutions including medical kiosks, portable telemedicine screening platforms, and remote diagnostic health screening. A doctor’s office with CSI Health solutions can see Patient A in person while visiting with Patient B via telemedicine.
Imagine both patients being seen for the same complaints. They both receive identical care. The person responsible for billing the visits has equal opportunity to up-code or exaggerate the time for either one. The telemedicine visit is not any more susceptible to fraudulent billing.
So, what’s the problem? Our billing and coding systems are so complex and convoluted that not even the most experienced industry expert can truly make sense of everything. Fraud is aided and abetted by the fundamental rule of technology that dictates more errors as complexity increases.
Reform the Billing System
If you want to greatly reduce healthcare fraud, the way to do it is to reform the billing system. Get rid of the fee-for-service model and start allowing healthcare providers to charge by the hour. While you’re at it, have patients pay for their healthcare out-of-pocket and then seek reimbursement from their insurance providers. Combine those two things and you will see fraud drop overnight.
Under the current system, fraud is allowed to perpetuate because no one is keeping an eye on things. Patients covered by health insurance have no idea how much their healthcare costs. Health insurance companies and Medicare alike do not pay attention to coding and billing either.
Telemedicine is here to stay, so let us avoid the temptation of making it the healthcare fraud bogeyman. Let’s put the blame for fraud where it belongs: on those perpetrating it.