According to the OIG, the claims should not have been paid because they did not contain sufficient documentation. CMS responded to the report by saying it will attempt to recoup the erroneous ED payments.
The OIG says Medicare erroneously allowed 19 percent of claims for interpretation and reports of CT and MRI services and 14 percent for interpretation and reports of X-ray services. The payments reportedly add up to nearly $38 million.
The OIG says the erroneous payments likely stem from ED failure to document physician orders or provide support that interpretation and reports were performed.
The OIG also found that interpretation and reports for 71 percent of X-rays and 69 percent of CTs and MRIs in EDs did not follow documentation proactive guidelines from the American College of Radiology. The OIG found that in 2008, Medicare paid more than $10 million for X-ray interpretation and report services and $19 million for MRI and CT interpretation and report services after patients left the ED.
Read the OIG April 2011 report “Medicare Payments for Diagnostic Radiology Services in Emergency Departments” (pdf).
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