Summary

Tightens program integrity for federal health care payments by shutting off billing identifiers for entities that are excluded, requiring fuller provider identification in Medicare Advantage encounter data, and adding a claims modifier to show when a telehealth company arranged a service and which practitioner delivered it. The Secretary of Health and Human Services must update rules by set deadlines and run annual checks of the exclusion list. Providers, telehealth companies, and Medicare Advantage plans will need to update systems and workflows to capture and report the new identifiers and relationships. The goal is to reduce improper payments and improve transparency and tracking in telehealth and other claims data.

Key Points

• Deactivates standard unique health identifiers for entities excluded from federal health care programs.
• Requires annual checks of the exclusion list to keep excluded entities from billing.
• Mandates provider identifiers be included in Medicare Advantage encounter data for certain items/services.
• Adds a claims modifier to flag telehealth company involvement and link companies to practitioners.
• Directs HHS to issue regulations and guidance by specified deadlines.
• Improves transparency and data quality for audits and program integrity.
• Requires system and workflow updates by providers, telehealth companies, and Medicare Advantage plans.
• Aims to reduce improper payments and strengthen oversight of telehealth arrangements.

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