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Other developments: CMS posts top RAC issues, OIG audits diagnostic radiology

Medicare Update for Physician Services, May 5, 2011

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CMS releases RAC top issues, recoupments to date

CMS has posted a summary document to outline the top audit issues for each RAC and provide aggregate recoupment amounts for the national program. From October 2009 through the end of March 2011, RACs have identified a total of $312.2 million in overpayments and $52.6 million in underpayments, totaling $365.8 million in total improper payments.

View the RAC summary.

CMS rescinds RAC audit of infusion claims

CMS’ physician regulatory issues team (PRIT) announced that it has worked with the RACs to rescind an audit of infusion code claims. The PRIT was contacted by a rheumatology practice that received a RAC notice of recoupment of payments for infusion codes submitted without a J code for the infused drug. Carrier policies vary on the correct way to submit claims for infusion when the drug infused is not billed to Medicare because it had been obtained, for instance, through a patient assistance program. It is not therefore possible to assume that an infusion claim lacking a drug J code should not have been paid.

OIG audits diagnostic radiology in the ED

On April 18, the OIG released a review of billing and reimbursement for professional services related to diagnostic radiology provided in emergency departments (ED). The OIG determined that in 2008, Medicare claims for interpretation and reports of 19% of CTs/MRIs and 14% of x-rays in hospital outpatient emergency departments were erroneous because of insufficient documentation.

View the OIG report.

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