Medicare spending on polysomnography services increased 39 percent from 2005 to 2011, from $407 million to $565 million, according to HHS' Office of the Inspector General. The OIG also found more than $17 million of the 2011 outlay was paid for these sleep study services that did not meet at least one of the three Medicare requirements for reimbursement.
The OIG report is based on analysis of 2011 polysomnography service claims from both hospital outpatient departments and nonhospital providers. Researchers identified the claims that did not meet Medicare requirements, along with the providers whose billing was deemed questionable using criteria from Medicare and outside sleep medicine professionals.
The OIG discovered $17 million in improper billings, mainly comprised of claims with the wrong diagnosis codes. The vast majority of claims with inappropriate diagnosis codes (85 percent) came from hospitals. The investigation also revealed 180 providers that exhibited patterns of questionable billing for polysomnography services. Most of these providers submitted reimbursement claims for a patient with another polysomnography claim on the same day, which is questionable as polysomnography services require an overnight stay and cannot happen more than once per day.
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