In 2008 Medicare erroneously allowed $38 million in claims for interpretation and reports of imaging in outpatient emergency departments, according to a report by the HHS Office of Inspector General.
Medicare wrongly allowed 19 percent ($29 million) of claims for interpretation and reports for CT and MRI and 14 percent ($9 million) of claims for interpretation and reports for X-rays because of insufficient documentation.
In 2008, 12 percent ($18 million) of allowed Medicare claims for CTs and MRIs in outpatient EDs did not document physicians' orders and 12 percent ($19 million) did not provide documentation to support that interpretation and reports had been performed. Five percent ($7.3) had overlapping errors. Of the allowed claims for X-rays in outpatient EDs, 8.6 percent ($5.5 million) did not include physicians' orders, 8.2 percent ($5.4 million) did not have documentation to support that interpretation and reports had been performed and 3 percent ($1.9 million) had overlapping errors.
In addition, CMS did not follow one or more of the documentation practice guidelines suggested by the American College of Radiology in approximately 71 percent of interpretation and reports for X-rays and 69 percent for CTs and MRIs.
OIG suggests CMS educate providers on documentation requirements for submitted claims, require that claims for interpretation and reports of imaging services be contemporaneous or identify when noncontemporaneous interpretations may benefit patients and take appropriate action on the erroneously allowed claims discussed in the OIG report.
Read the OIG report on erroneously allowed Medicare claims.
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- CMS Proposes 0.5% Cut in Medicare Payments to Hospitals for FY12
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Medicare wrongly allowed 19 percent ($29 million) of claims for interpretation and reports for CT and MRI and 14 percent ($9 million) of claims for interpretation and reports for X-rays because of insufficient documentation.
In 2008, 12 percent ($18 million) of allowed Medicare claims for CTs and MRIs in outpatient EDs did not document physicians' orders and 12 percent ($19 million) did not provide documentation to support that interpretation and reports had been performed. Five percent ($7.3) had overlapping errors. Of the allowed claims for X-rays in outpatient EDs, 8.6 percent ($5.5 million) did not include physicians' orders, 8.2 percent ($5.4 million) did not have documentation to support that interpretation and reports had been performed and 3 percent ($1.9 million) had overlapping errors.
In addition, CMS did not follow one or more of the documentation practice guidelines suggested by the American College of Radiology in approximately 71 percent of interpretation and reports for X-rays and 69 percent for CTs and MRIs.
OIG suggests CMS educate providers on documentation requirements for submitted claims, require that claims for interpretation and reports of imaging services be contemporaneous or identify when noncontemporaneous interpretations may benefit patients and take appropriate action on the erroneously allowed claims discussed in the OIG report.
Read the OIG report on erroneously allowed Medicare claims.
Read more coverage on Medicare:
- CMS Proposes 0.5% Cut in Medicare Payments to Hospitals for FY12
- Patient Death Puts University of Chicago Medical Center's Medicare Funding at Risk
- Obama's Plan to Reduce Deficit Will Preserve Medicare, Medicaid But Includes "Tough Cuts"