Corporate Compliance

OIG: Stent placement services received overpayments

Compliance Monitor, August 24, 2005

Medicare overpaid 15 providers a total of $35,291 for claims that did not meet requirements for outpatient stent placement services.

In an audit of records from 2002, the OIG determined that errors may have occurred because the providers did not have procedures in place to ensure that the services met Medicare billing requirements. Furthermore, the audit determined that providers may need additional education covering proper billing practices for stent services.

The OIG recommends that the TrailBlazer Health Enterprises, LLC, a Medicare contractor, recover $35,291 in overpayments and provide education to providers to ensure that claims meet Medicare's requirements.

To perform the audit, the OIG selected 100 claims and obtained copies of the medical records from each of the Medicare providers that submitted the claims. The OIG then provided copies of the medical records to the contractor TriCenturion, which reviewed each to determine if the services billed met Medicare reimbursement requirements.

    Click here to read the audit report, " Review of the Services Related to the Placement of Arterial Stents," (A-06-04-00091) issued August 5, 2005.

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