News | October 09, 2009

OIG to Review Radiology Payments, Appropriateness

October 9, 2009 - The U.S. Department of Health and Human Services Office of Inspector General (OIG) will open new studies regarding Medicare Part B imaging payments and appropriateness of many emergency department scans according to the recently released OIG Fiscal Year 2010 Work Plan, reported the American College of Radiology.

OIG functions under Congress’ mandate to review healthcare-related programs and operations. The Work Plan is the OIG's annual "playbook" of upcoming investigations, audits, and reports. Its Work Plan lists health care arrangements it believes cost too many dollars or could violate federal fraud and abuse laws. ACR/ACRA members who render patient care in the areas listed in the Work Plan should not expect an immediate knock on their office door from the OIG. However, it could happen, and to be prepared, radiologists and their staffs should properly document the medical necessity of and correctly code for their services.

OIG plans to examine the practice expense components of selected imaging services, including the controversial equipment utilization rate — does it reflect “current industry practice?” The Radiology Business Management Association recently published a study confirming that the actual equipment utilization rate nationwide is only 54 percent — well below the 75 percent assumption called for in House health care reform legislation.

Additionally, OIG will continue its anticipated review of whether Medicare payments for emergency department X-rays and interpretations are appropriate. Other notable projects include an ongoing examination of services and billing patterns in locations with a high density of Independent Diagnostic Testing Facilities (IDTFs).

OIG also will start inspecting the degree to which data and safety monitoring boards assess safety data in clinical trials. ACR/ACRA members who participate in clinical trials should discuss the role of such boards with their institutions.
OIG's 2010 Work Plan

For more information: www.acr.org

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