Doctors who order MRIs from providers with whom they have a business relationship are more likely to be high users of the service, HHS inspector generals office concluded from a review of claims paid under the Medicare physician fee schedule. The reportwhich was inspired by previous work by the office showing a fourfold increase in MRI claims paid under the fee schedule from 1995 to 2005examines connections between utilization and the way the service is provided based on 2005 claims data. Orthopedic surgeons were the most likely to order what the report calls connected services based on the business relationships of the parties involved. The review also revealed that MRIs that were considered connected services were more likely to have taken circuitous billing paths. The complexity and limited transparency with which these services are provided warrants continued attention to ensure that services are reasonable, necessary and compliant with Medicare statutes and regulations, the report states. In a letter to the inspector generals office in response to a draft of the findings, acting CMS Administrator Kerry Weems writes that the agency is striving for the right balance between allowing arrangements that improve access and prohibiting ones that are abusive.
Doc business connections increase MRI use: report
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