OIG Examines Medicare Radiology Services in Emergency Departments
The OIG has issued a report entitled “Medicare Payments for Diagnostic Radiology Services in Emergency Departments.” According to the OIG, because of insufficient documentation, Medicare erroneously allowed 19% ($29 million) of claims for interpretation and reports for computed tomography and magnetic resonance imaging, along with 14% ($9 million) of claims for interpretation and reports for x-rays in hospital outpatient emergency departments in 2008. Examples of insufficient documentation included missing physicians’ orders and records documenting that interpretation and reports had been performed. The OIG investigators also measured compliance with reporting guidelines recommended by the American College of Radiology. The report did not address the widespread delivery of preliminary interpretation services in thousands of US hospitals. The OIG recommended that CMS improve provider education regarding documentation requirements and take appropriate action on the erroneously allowed claims identified by the OIG; CMS concurred with these recommendations. CMS did not agree with a separate OIG recommendation that CMS require that claimed services be contemporaneous or identify circumstances in which noncontemporaneous interpretations may be appropriate; CMS noted that it does not believe that a single billed interpretation must in all cases be contemporaneous with the beneficiary’s diagnosis and treatment to contribute to that diagnosis and treatment.
