Evidence record
Summary of Results: Psychiatric and Behavioral Health Teleservices in Texas Medicaid and CHIP
- Jurisdiction
- Texas
- Audit organization
- Texas Health and Human Services Office of Inspector General Audit and Inspections Division
- Publication date
- November 21, 2024
- Source record
- Original document linked
Findings
6
Recommendations
2
Overall conclusion
While all five providers complied with some of the requirements tested, each had at least one finding of noncompliance.
Scope
Texas Medicaid and CHIP teleservices claims paid to five providers during the period: Providers A and B (June 1, 2020–May 31, 2021) for evaluation and management with add-on psychotherapy; Providers C and D (June 1, 2021–December 31, 2021) for evaluation and management, psychiatry, and psychotherapy; Provider E (September 1, 2020–August 31, 2022) for Texas Medicaid teleservices.
Findings (6)
Each finding has a stable link.
- F-1161
Billing incorrect CPT or HCPCS codes.
- F-1162
Billed services delivered by providers not enrolled in Texas Medicaid.
- F-1163
Double billed for services.
- F-1164
Billed for unallowable facility fees.
- F-1165
Did not always maintain complete records.
- F-1166
Two providers did not always notify patients about their privacy practices prior to the start of telemedicine evaluation or treatment.
Recommendations (2)
- R-1034
In addition to returning $936.02 to the state of Texas, [Provider A] should implement processes to ensure that (a) claims for services billed as time-based CPT codes are based on the actual length of services provided and (b) medical records include documentation to support the CPT codes billed.
Related finding F-1161 - R-1035
[Provider A] should provide patients with written or electronic notification of its privacy practices prior to evaluation or treatment via telemedicine services.
Related finding F-1166