Part B Insider (Multispecialty) Coding Alert

Published on Sat Jun 20, 2009 PDF

Plus: The OIG identified 20 counties it classifies as "high use" for ultrasounds.

The OIG is watching ultrasound claims -- and it doesn't like what it sees.

An OIG audit of ultrasound services billed in 2007 found that nearly one in five ultrasound claims "had characteristics that raise concerns about whether the claims are appropriate," according to a July 2009 audit report entitled "Medicare Part B Billing for Ultrasound."

The most common error: 17 percent of Part B ultrasound claims billed in 2007 lacked prior service claims by the ordering physician, the OIG indicated.

What this means: Several physicians ordered ultrasounds for patients that they hadn't treated within the last year. "No visit to the ordering physician would be suspicious because the OIG would wonder why the doctor would order an ultrasound for a patient who he hasn't examined," notes Allison Larro, Esq., an Atlanta-based attorney. "In the report, the OIG indicates that ultrasound service claims 'fell on the same day or within 30 days prior to the ultrasound claim 72 percent of the time.'"

Plus: Four percent of providers who billed for ultrasounds "lacked preceding or same-day service claims from the ordering doctors for all ultrasound claims they billed." Collectively, these claims totaled over $4.8 million in allowed charges.

Geographic issues: The OIG also found that 20 counties classified as "high use" accounted for 16 percent of Part B spending on ultrasounds, even though those counties only housed 6 percent of Medicare beneficiaries.

"This resulted in Medicare spending $171 per beneficiary on ultrasounds in those counties, whereas the national average is $55 per patient," Larro says. The report lists all of the highuse counties, but the top three are Kings County, N.Y., Miami-Dade, Fla., and Nassau, N.Y.

The fallout: In the audit report, the OIG noted that it will "forward questionable claims identified by this report to its Recovery Audit Contractors to consider in prioritizing areas for postpayment review."

In other words: RACs will most likely be looking carefully at ultrasound services in the coming months -- so you should do so, too.