OIG Asks CMS to Keep an Eye on Electrodiagnostic Testing

U.S. Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a report on April 7, 2014 identifying electrodiagnostic testing as an area of questionable billing, vulnerable to fraud, waste, and abuse. Electrodiagnostic tests are used to evaluate patients with nerve damage. Investigations revealed that in 2011:

• Medicare paid approximately $486 million to 21,700 physicians who billed for electrodiagnostic tests for 877,000 beneficiaries.
• 4,901 physicians had questionable billing for Medicare electrodiagnostic tests totaling $139 million.
• The Medicare Fraud Strike Force charged a group of physicians with $113 million for fraudulently billing Medicare. The fraudulent claims included electrodiagnostic tests.
• Physicians in the New York, Los Angeles, and Houston areas had the highest questionable billing for Medicare electrodiagnostic tests.

To help keep questionable billing of electrodiagnostic testing to a minimum, OIG recommends that the Centers for Medicare & Medicaid Services (CMS):

1. Increase its monitoring of billing for electrodiagnostic tests;
2. Provide additional guidance and education to physicians regarding electrodiagnostic tests; and
3. Take appropriate action regarding physicians whom the OIG identified as having inappropriate or questionable billing.

CMS issues comparative billing reports to providers, which include electrodiagnostic testing. The reports provide education to clinical professionals to help them identify and correct billing errors.

Source: Questionable Billing for Medicare Electrodiagnostic Tests (OEI-04-12-00420)

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Michelle Dick

Executive Editor at AAPC

Michelle A. Dick has been executive editor for AAPC for over 10 years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. She has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.

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