July 17, 2009 - In 2007, 20 high-use counties accounted for 16 percent of Part B spending on ultrasound despite having only 6 percent of Medicare beneficiaries, according to findings from a report issued by the office of Inspector General (OIG) released on July 10, 2009
The 20 high-use counties accounted for $336 million of the $2.1 billion in Part B spending on ultrasound services. The average per-beneficiary spending on ultrasound in these counties was three times higher than for the rest of the country.
The report, based on a study conducted on Part B providers billing practices for ultrasound services, indicates that The Centers for Medicare and Medicaid Services (CMS) spent approximately $2 billion for ultrasound services in the ambulatory setting in 2007. Based on 2007 Medicare claims data, 20 counties in the country were identified for their high utilization rate (top 1 percent). Spending on ultrasound services in these counties made up 16 percent of Part B spending.
According to the report, ultrasound claims in high-use counties exhibited questionable billing characteristics, which included:
- Lack of prior service claim by the ordering physician for treating the beneficiary.
- Combinations of ultrasound services billed for the same beneficiary on the same day by the same provider.
- Claims for specific procedures that are not effective in adults.
- Duplicative services (e.g. claims for complete studies as well as limited study for a specific organ).
- More than 5 ultrasound studies performed on a patient on the same day by the same provider.
- More than 5 providers billing for ultrasound services for the same beneficiary.
- Failing to identify the ordering physician on a claim.
The OIG has recommended that Medicare monitor ultrasound claims with these questionable characteristics more closely based on the findings of this study. CMS agreed to inform the Recovery Audit Contractors (RAC) to pay close attention to ultrasound claims.
For more information: www.oig.hhs.gov