The CMS should not have paid nearly one-fifth of the 3 million Medicare claims related to interpretation and reports of CT and MRI scans in 2008, according to a claims-sampling report (PDF) by the HHS inspector general.
Report notes erroneous CT, MRI payments
Those “erroneously allowed” payments cost $29 million and were made in cases lacking either physicians' orders or other documentation or both.
Likewise, about 14% of 2008 Medicare claims paid for X-ray interpretation and reports—totaling nearly $9 million—lacked the required documentation.
The CMS agreed to educate providers on the documentation requirements for imaging services, according to the HHS inspector general, and the agency agreed to send the information from the erroneously allowed claims found in the review to its recovery audit contractors.
However, the CMS balked at the suggestion that it adopt a uniform policy requiring that clinicians either perform the imaging at the same time as their patients' diagnosis and treatment or explain why it did not occur at the same time.
“We do not agree that, in all cases, this single billed interpretation must be contemporaneous with the beneficiaries' diagnosis and treatment in order to contribute to that diagnosis and treatment,” wrote Dr. Donald Berwick, CMS administrator, in a Dec. 22 letter to HHS Inspector General Daniel Levinson responding the findings.
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