Key Takeaway  
U.S. Department of Health and Human Services   
Office of Inspector General 
 
Data Snapshot  
 
October 2021, OEI-02-20-00521  
Most Medicare beneficiaries received telehealth services only 
from providers with whom they had an established relationship 
Background 
 
In response to the COVID-19 pandemic, both Congress and the Department of Health 
& Human Services (HHS) expanded access to a wide range of medical services that   
can be delivered via telehealth (i.e., telehealth services).  This expansion enhanced the 
 
ability of health care providers to offer care to Medicare beneficiaries remotely during 
the COVID-19 pandemic.  Prior to the pandemic, beneficiaries were only able to  
84% 
receive certain telehealth services from providers with whom they had an established  of
relationship.1  However, HHS announced that it will use its discretion to not enforce  beneficiaries 
requirements for established relationships during the pandemic.2   received all their 
telehealth services 
While the expansion of telehealth has been essential to maintaining beneficiaries 
from providers with 
access to care, there have been concerns about the potential for fraud, waste, and 
whom they had an 
abuse associated with expanded telehealth services.3  This data snapshot provides 
established 
information to policymakers and other stakeholders about the relationship between 
relationship. 
beneficiaries and providers of telehealth services.  These data are critical to informing 
decisions about how to structure telehealth services in Medicare on a more  
permanent basis.  Understanding how likely beneficiaries are to receive telehealth 
services from a provider with whom they have had an established relationship, and the 
average timeframe between an in-person visit and a telehealth service, can help 
inform decisions on how frequently in-person care may need to be paired with 
telehealth services.  This snapshot is part of a series of reports on telehealth; the other 
reports focus on telehealth utilization and program integrity. 
  Results   
Eighty-four percent of beneficiaries received 
  
84 percent  of beneficiaries received 
telehealth services only from providers with whom 
telehealth services only from providers 
they had an established relationship. 
with whom they had an  established 
In total, 26 million beneficiaries, representing 39 percent of  relationship.  
all Medicare beneficiaries, received at least one telehealth 
service from March through December 2020.4  Slightly more 
than half of these beneficiaries were enrolled in traditional 
Medicare (also known as Medicare fee-for-service), while 
the remainder were enrolled in Medicare Advantage. 
Eighty-four percent of these beneficiaries received all their 
telehealth services from providers with whom they had an 
established relationship.  These beneficiaries had an in-
person visit or other service with each of their providers 
prior to their telehealth service.5  The remaining 16 percent 
16 percent  received telehealth services 
of beneficiaries received telehealth services from at least  
from at least one provider with whom 
one provider with whom they had no prior relationship. 
they had no prior  relationship.  
1   The proportion of beneficiaries receiving telehealth services from providers with whom they had 
an established relationship varied by type of service. 
Beneficiaries most commonly received e-visits, virtual check-ins, and telephone evaluation and management 
services via telehealth from providers with whom they had an established relationship.  E-visits and virtual 
check-ins are brief telephone calls or online interactions via a patient portal.  Telephone evaluation and 
management services are telephone calls to discuss a beneficiarys medical condition; these calls can last up to 
half an hour.  In total, 84 percent of beneficiaries who had e-visits and virtual check-ins and 84 percent of 
beneficiaries who had telephone evaluation and management services via telehealth had an established 
relationship with their providers.  These high proportions are not surprising because these types of services are 
designated for beneficiaries who have established relationships with their providers. 
Importantly, 83 percent of beneficiaries who received office 
visits via telehealth had an established relationship with 
their providers.  These office visits are conducted via 
telehealth as opposed to in person and were the most 
common type of telehealth service.  In total, beneficiaries  Office visits represented 48 percent  
received about 45.5 million office visits delivered via  of all services provided via telehealth 
telehealth, which accounted for nearly half of all telehealth  during the pandemic. These visits 
services provided from March through December 2020.  include services with primary care 
providers and specialists for the 
Beneficiaries who received home visits via telehealth, which 
purpose of evaluating or managing 
represented only 1 percent of all services provided via 
the beneficiarys medical condition. 
telehealth, were the least likely to have an established 
relationship with their providers; only 34 percent had such 
a relationship.  Prior to the pandemic, providers typically 
conducted home visits to evaluate and provide care to 
beneficiaries in their home.6  During the pandemic, these 
home visits were conducted via telehealth. 
 T he proportion of beneficiaries receiving telehealth services from providers with whom 
they had an established relationship varied for the most common services. 
Source: OIG analysis of Medicare data, 2021. 
  2   Beneficiaries in traditional Medicare were more likely to receive telehealth services from providers 
with whom they had an established relationship, compared to beneficiaries in Medicare Advantage. 
Overall, a smaller proportion of beneficiaries enrolled in traditional Medicare received telehealth services, 
compared to beneficiaries enrolled in Medicare Advantage.  Specifically, one-third of beneficiaries in 
traditional Medicare, compared to 45 percent of beneficiaries in Medicare Advantage, received telehealth 
services from March to December 2020.  Prior to the pandemic, Medicare did not allow beneficiaries in 
traditional Medicare to receive telehealth services in their homes and only covered telehealth services in rural 
areas.7  In contrast, Medicare Advantage plans had greater flexibility to provide telehealth services to 
beneficiaries.  For example, plans could provide services to beneficiaries in their homes and regardless of their 
geographic location.8  
While a smaller proportion received telehealth services, beneficiaries in traditional Medicare were slightly more 
likely to receive telehealth services from providers with whom they had an established relationship than 
beneficiaries in Medicare Advantage.  In total, 86 percent of beneficiaries in traditional Medicare received a 
telehealth service from providers with whom they had an established relationship, compared to 81 percent of 
beneficiaries in Medicare Advantage.  This was true for nearly all of the most common services.  The only 
exception to this was physical, occupational, and speech therapy.   
 
  Beneficiaries enrolled in traditional Medicare were  more likely  to have an  established 
relationship  with providers for most  types of services. 
 
Source: OIG analysis of Medicare data, 2021.  
3  
  Beneficiaries had in-person visits with their providers an average of 4 months prior to their first 
telehealth service. 
In general, beneficiaries who had an established relationship with their providers had an in-person visit an 
average of 4 months prior to their first telehealth service.  This was true for both beneficiaries in traditional 
Medicare and beneficiaries in Medicare Advantage. 
However, the average amount of time between beneficiaries in-person visits and their first telehealth services 
varied by type of service.  Beneficiaries who received home visits via telehealth had an in-person visit with 
their providers almost 9 months, on average, prior to their first telehealth service.  In contrast, beneficiaries 
who received nursing home visits and assisted living visits via telehealth  had an in-person visit more recently, 
an average of 2 months prior to their first telehealth service.   
 
 
   
Beneficiaries had in-person visits with their providers  between an average of 2 to 9 months 
prior to their first telehealth service. 
 
 
Source: OIG analysis of Medicare data, 2021. 
4  
  Conclusion 
From March through December 2020, 26 million beneficiaries accessed essential health care services via 
telehealth.  Examining how beneficiaries used telehealth during this time can help inform policy decisions 
about structuring the Medicare telehealth benefit on a more permanent basis. 
Most beneficiaries received telehealth services from providers with whom  they had an established relationship. 
Notably, 84 percent of beneficiaries received telehealth services only from providers with whom they had an 
established relationship.  Those enrolled in traditional Medicare were more likely to receive services from 
providers with whom they had an established relationship, compared to beneficiaries in Medicare Advantage. 
This pattern persisted among virtually all of the most common telehealth services.  Beneficiaries tended to see 
their providers in person about 4 months prior to their first telehealth service, on average. 
These data can be used to inform decisions about how to best use telehealth in Medicare and should be taken 
into account as policymakers continue to examine telehealth utilization and concerns about telehealth being 
vulnerable to fraud, waste, and abuse.  This includes decisions about which services to allow to be delivered via 
telehealth on a more permanent basis and to what extent Medicare should require that beneficiaries have a 
relationship with their providers prior to receiving certain telehealth services. 
Methodology  
For our analyses, we reviewed traditional Medicare claims and Medicare Advantage encounter claims data for 
telehealth services provided from March through December 2020.9  First, we determined the proportion of 
beneficiaries who received telehealth  services only from providers with whom they had an established 
relationship and the proportion who received at least one telehealth service from a provider with whom they 
had no established relationship.  To determine if a beneficiary had an established relationship with each 
provider, we identified the date of the first telehealth service with the provider and looked back to January 
2018 to determine if the beneficiary had a prior in-person visit or other service with that same provider (i.e., any 
provider with the same billing number, such as providers in the same practice).  We then conducted this 
analysis for the 10 most common types of telehealth services.  Using these categories, we analyzed the 
proportion of beneficiaries enrolled in traditional Medicare and those enrolled in Medicare Advantage who had 
an established relationship with their providers.  In addition, for beneficiaries who had an established 
relationship with their providers, we determined the average amount of time between their first telehealth 
service and their most recent in-person visit for each of their providers.  We conducted this analysis for 
different types of services. 
Standards  
We conducted this study in accordance with the Quality Standards for Inspection and Evaluation issued by the 
Council of the Inspectors General on Integrity and Efficiency. 
Acknowledgments  
Judy Kellis served as the team leader  for this study.  Others in the Office of Evaluation and Inspections who 
conducted the study include Alexis Mills.  Office of Evaluation and Inspections staff who provided support 
include Rob Gibbons.  This report was prepared under the direction of Jodi Nudelman, Regional Inspector 
General for Evaluation and Inspections in the New York regional office, and Nancy Harrison and Meridith Seife, 
Deputy Regional Inspectors General. 
To obtain additional information concerning this report or to obtain copies, contact the Office of Public Affairs 
at Public.Affairs@oig.hhs.gov. 
5      Sources    
1 Certain servicessuch as remote patient monitoring, e-visits, virtual check-ins, and telephone evaluation and 
management servicesare designated for beneficiaries who have an established relationship with their 
providers. See 85 Fed. Reg. 19230 (April 6, 2020). 
2 CMS, Medicare Telemedicine Health Care Provider Fact Sheet, March 2020.  Accessed at 
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet on May 
24, 2021.  
3 MedPac, Telehealth in  Medicare after the coronavirus public health emergency, March 2021.  Accessed at 
http://www.medpac.gov/docs/default- source/reports/mar21_medpac_report_ch14_sec.pdf?sfvrsn=0  on 
August 2, 2021.  
4 This analysis is based on telehealth services rendered and billed by individual clinicians, such as office visits, 
psychotherapy, and other patient evaluation and management services.  It does not include telehealth 
services billed for hospital services, psychological testing, and behavioral assessments because beneficiaries 
are not expected to commonly have established relationships with providers of these services. 
5 To determine if a beneficiary had an established relationship with each provider, we identified the date of the 
first telehealth service with the provider and looked back to January 2018 to determine if the beneficiary had 
a prior in-person visit or other service with that same provider (i.e., any provider with the same billing 
number, such as providers in the same practice). 
6 A home visit is defined as evaluation and management services provided by a physician to a beneficiary in 
their private residence.  Unlike with home health services, the beneficiary does not need to be confined to 
their home to receive a home visit.  See CMS, Medicare Claims Processing  Manual, Ch. 12 - 
Physicians/Nonphysician Practitioners, section 30.6.14.1, March 2021. Accessed at 
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf  on         
May 28, 2021. 
7 Medicare made exceptions to the geographic restrictions in traditional Medicare for services related to acute 
stroke, dialysis, and substance use disorder.  Beginning in January 2019,  Medicare allowed beneficiaries to 
receive renal dialysis and acute stroke related services in their own homes via telehealth, regardless of 
geographic location.  See 84 Fed. Reg. 15680 (April 16, 2019).  Beginning in July 2019, it allowed beneficiaries 
to receive telehealth services in their own homes regardless of their geographic location if the services are to 
treat a substance use disorder or a co-occurring mental health disorder.  See Substance Use-Disorder 
Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT,   
Pub. L. No. 115-271), October 24, 2018.  
8 See 84 Fed. Reg. 15680 (April 16, 2019). 
9 The analysis is based on services rendered and billed by individual clinicians.  In addition, we did not include 
telehealth services billed for hospital services, psychological testing, and behavioral assessments because 
beneficiaries are not expected to commonly have established relationships with providers of these services. 
6