Audit finds CMS overpaid hospitals as much as $25.8M for IMRT planning services
Medicare overpaid hospitals as much as $25.8 million for intensity-modulated radiation therapy (IMRT) planning services, according to an audit conducted by the Office of Inspector General (OIG) of HHS.
“Specifically, for all 100 line items in our sample, the hospitals separately billed for complex simulations when they were performed as part of IMRT planning,” according to the OIG statement. “The overpayments primarily occurred because the hospitals appeared to be unfamiliar with or misinterpreted the Centers for Medicare & Medicaid Services (CMS) guidance. In addition, the claim processing edits did not prevent the overpayments because the edits applied only to services billed on the same date of service as the billing of the procedure code for the bundled payment, and the services in our sample were billed on a different date of service.”
The audit period was from 2013 through 2015. In addition, for the two years after the audit period, Medicare potentially overpaid hospitals as much as $5.4 million.
The OIG recommended that CMS “implement an edit to prevent improper payments for IMRT planning services that are billed before (e.g., up to 14 days before) the procedure code for the bundled payment for IMRT planning is billed, which could have saved as much as $25.8 million during our audit period and as much as $5.4 million in the two years after our audit period.”
CMS has said it agrees with the office’s findings and recommendations, providing written details on steps it has taken to resolve these issues.
The complete OIG report is available here. A report brief is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.