OIG Finds Inappropriate Medicare Payments for Transforaminal Epidural Injection Services
Chicago —
(August 25, 2010)
A recent report issued by the Office of Inspector General (OIG) found that Medicare Part B physician payments for transforaminal epidural injections increased nearly 150% from $57 million in 2003 to $141 million in 2007. Further, according to the OIG, 35% of transforaminal injection services allowed by Medicare in 2007 did not meet Medicare requirements, resulting in approximately $45 million in improper payments. An additional $23 million in associated facility claims was allowed by Medicare. Finally, OIG found that services provided in offices were more likely to have a documentation error than those provided in ASCs or hospital outpatient departments.
Based on the review, OIG recommends that CMS conduct provider education, directly and through contractors, about proper documentation and strengthen program safeguards to prevent improper payment for transforaminal epidural injection services. In addition, OIG recommends that CMS take appropriate action regarding the undocumented, medically unnecessary, and miscoded services identified in the sample.
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Anesthesiologists: Physicians providing the Lifeline of Modern Medicine TM. Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with more than 50,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists website at www.asahq.org.
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