The Department of Health and Human Services, Office of the Inspector General (OIG), has identified 20 portable X-ray suppliers with "questionable billing patterns," according to a report issued Tuesday.
OIG researchers said they used 2008 and 2009 Medicare claims data, nursing home stay data, and provider enrollment data to examine portable X-ray suppliers' billing patterns and to identify individual claims that may warrant further review. In the report, the OIG found Medicare paid approximately $225 million for all X-rays rendered in 2009 by portable X-ray suppliers.
According to OIG, portable X-ray suppliers are entities that furnish X-rays at a beneficiary's location using mobile diagnostic equipment. Medicare pays portable X-ray suppliers separately for the transportation and setup of the mobile equipment in addition to the administration of the test and interpretation of the results.
[See also: OIG comes down on Medicare physician home health billing .]
By law, portable X-rays must be ordered by a licensed physician. In 2009, however, the OIG found that Medicare paid approximately $6.6 million for portable X-rays ordered by nonphysicians.
In addition to finding the 20 X-ray suppliers with questionable billing patterns, the OIG said it also found that Medicare paid approximately $12.8 million for return trips to nursing facilities on a single day. OIG officials are concerned that some X-ray suppliers may have called for residents to leave their facilities to receive a portable X-ray, only to be returned to their nursing home the same day.
The OIG recommended that the Centers for Medicare & Medicaid Services (CMS) crack down on portable X-ray suppliers referred by OIG.
OIG also recommended that CMS establish a process for routinely finding portable X-ray suppliers that merit greater scrutiny.
According to OIG, CMS should also determine what portion of the $12.8 million it paid for return trips to nursing homes in 2009 actually reimbursed portable X-ray suppliers for incorrectly billed transportation component claims and collect any overpayments, OIG said.
OIG also called on CMS to collect the $6.6 million in overpayments it made for portable X-ray services rendered in 2009 that were ordered by nonphysicians.
In addition, CMS should also implement procedures to ensure that it pays for portable x-ray services only when they are ordered by a physician and establish appropriate controls, the report said.
According to the OIG report, CMS agreed with all of OIG's recommendations.
Read the full OIG report here.
[See also: OIG to monitor Medicare, Medicaid IT upgrades, incentives.]
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