Physicians billed $139 million in 2011 for questionable Medicare electrodiagnostic tests, a service area that is vulnerable to fraud, waste, and abuse, according to a report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released April 7. The report, “Questionable Billing for Medicare Electrodiagnostic Tests” (OEI-04-12-00420), found that 4,901 physicians of the 21,663 physicians who billed for electrodiagnostic tests in 2011 met or exceeded the threshold for one or more questionable billing measures for electrodiagnostic tests. In 2011, Medicare paid approximately $486 million to 21,700 physicians who billed for electrodiagnostic tests for 877,000 beneficiaries. Of the physicians with questionable billing, the OIG found that 49 percent were neurologists and physiatrists who “have special training in electrodiagnostic medicine, and therefore may see more patients who require electrodiagnostic testing, and may bill for more of these tests.” Electrodiagnostic tests are intended to evaluate a patient’s nerves for potential damage. The tests measure electrical activity in muscles and nerves and can detect peripheral nerve damage caused by conditions such as diabetes and carpal tunnel syndrome. The OIG report discovered that 4,257 physicians exceeded the threshold for one of the questionable billing measures, 572 exceeded the threshold for […]
Physicians billed $139 million in 2011 for questionable Medicare electrodiagnostic tests, a service area that is vulnerable to fraud, waste, and abuse, according to a report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released April 7.
The report, “Questionable Billing for Medicare Electrodiagnostic Tests” (OEI-04-12-00420), found that 4,901 physicians of the 21,663 physicians who billed for electrodiagnostic tests in 2011 met or exceeded the threshold for one or more questionable billing measures for electrodiagnostic tests.
In 2011, Medicare paid approximately $486 million to 21,700 physicians who billed for electrodiagnostic tests for 877,000 beneficiaries.
Of the physicians with questionable billing, the OIG found that 49 percent were neurologists and physiatrists who “have special training in electrodiagnostic medicine, and therefore may see more patients who require electrodiagnostic testing, and may bill for more of these tests.”
Electrodiagnostic tests are intended to evaluate a patient’s nerves for potential damage. The tests measure electrical activity in muscles and nerves and can detect peripheral nerve damage caused by conditions such as diabetes and carpal tunnel syndrome.
The OIG report discovered that 4,257 physicians exceeded the threshold for one of the questionable billing measures, 572 exceeded the threshold for two, and 72 exceeded the threshold for three.
OIG Recommendations
The OIG said physicians may have legitimate reasons for the electrodiagnostic test billings identified in the report but further attention is warranted. As a result, the OIG recommended that the Centers for Medicare and Medicaid Services (CMS) strengthen the monitoring of electrodiagnostic test billings.
The OIG also recommended that the CMS should educate physicians on proper billing procedures for electrodiagnostic tests, as well as take any appropriate actions against the identified physicians with questionable billing practices.
The CMS partially agreed with the first and second recommendations and said it “will need to evaluate if implementing new thresholds that trigger additional manual medical review by CMS MACs is cost-effective given the high cost of medical review.”
The CMS fully agreed with the third recommendation, to take appropriate action against physicians identified in the report, and asked the OIG to provide additional information on the questionable billing claims identified in the report.
Takeaway: CMS is likely to strengthen its monitoring of electrodiagnostic test billings after the HHS OIG identified $139 million in questionable billings.
