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Three OIG Reports Review Medicare E/M Services

By Debra A. McCurdy on May 14, 2012

The OIG has issued three reports on Medicare evaluation and management (E/M) services, reviewing use of higher-level E/M codes and E/M services included in cardiovascular and musculoskeletal global surgery fees. The first report, “Coding Trends of Medicare Evaluation and Management Services,” found that from 2001 to 2010, physicians increased their billing of higher level E/M codes for all types of services.  The OIG also identified approximately 1,700 physicians who consistently billed higher level E/M codes in 2010. While the OIG did not determine whether physicians who billed higher level E/M codes billed inappropriately, subsequent evaluations will determine the appropriateness of Medicare payments for E/M services and the extent of documentation vulnerabilities in E/M services. In the meantime, the OIG recommends that CMS (1) continue to educate physicians on proper billing for E/M services; (2) encourage its contractor to review physicians’ billing for E/M services; and (3) review physicians who bill higher level E/M codes for appropriate action. In a second report, “Cardiovascular Global Surgery Fees Often Did Not Reflect the Number of Evaluation and Management Services Provided,” the OIG estimates that Medicare paid a net $14.6 million for E/M services that were included in cardiovascular global surgery fees but not provided during the global surgery periods in 2007. The OIG recommends that CMS adjust the estimated number of E/M services within cardiovascular global surgery fees to reflect the actual number of E/M services being provided to beneficiaries, or use the results of this audit during the annual update of the physician fee schedule.  Similarly, in a report entitled “Musculoskeletal Global Surgery Fees Often Did Not Reflect the Number of Evaluation and Management Services Provided,” the OIG reviewed of a sample of 300 musculoskeletal global surgeries. The OIG estimates that Medicare paid a net $49 million for E/M services that were included in musculoskeletal global surgery fees but not provided during the global surgery periods in 2007. The OIG recommends that CMS adjust the estimated number of E/M services within musculoskeletal global surgery fees to reflect the actual number of E/M services being provided to beneficiaries, or use the results of this audit during the annual update of the physician fee schedule. Note that the OIG did not determine the medical necessity of the cardiovascular or musculoskeletal surgeries or the related E/M services.

 

  • Posted in:
    Health Care
  • Blog:
    Health Industry Washington Watch
  • Organization:
    Reed Smith LLP
  • Article: View Original Source

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