OIG Releases Report on Ultrasound Medicare Part B Billing
The office of Inspector General (OIG) released a report [on July 10, 2009] based on a study conducted on Part B providers billing practices for ultrasound services. The report indicates that Medicare spent approximately $2 billion for ultrasound services in the ambulatory setting in 2007. Based on 2007 Medicare claims data, 20 counties in the country were identified for their high utilization rate (top 1 percent).
The OIG report states that Medicare spending on ultrasound services was three times higher in these counties than for the rest of the country, and made up 16 percent of Part B spending. The review of the ultrasound claims of the high-use counties exhibited questionable billing characteristics, which included:
- Lack of prior service claim by the ordering physician for treating the beneficiary.
- Combinations of ultrasound services billed for the same beneficiary on the same day by the same provider.
- Claims for specific procedures that are not effective in adults.
- Duplicative services (e.g. claims for complete studies as well as limited study for a specific organ).
- More than 5 ultrasound studies performed on a patient on the same day by the same provider.
- More than 5 providers billing for ultrasound services for the same beneficiary.
- Failing to identify the ordering physician on a claim.
The OIG has recommended that Medicare monitor ultrasound claims with these questionable characteristics more closely based on the findings of this study. The Centers for Medicare and Medicaid Services (CMS) agreed with the OIG’ s recommendation and will inform the Recovery Audit Contractors (RAC) to pay close attention to ultrasound claims. .
To obtain the copy of the report, please visit OIG’s Web site at
http://www.oig.hhs.gov/oei/reports/oei-01-08-00100.pdf, and see the July/August 2009 issue of the ACR Radiology Coding Source for guidance on appropriate ultrasound coding and billing practices.
