OIG Finds Inappropriate Medicare Payments for Transforaminal Epidural Injection Services
(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
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 50,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring that physician anesthesiologists evaluate and supervise the medical care of patients before, during, and after surgery to provide the highest quality and safest care that every patient deserves.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount. Join the ANESTHESIOLOGYTM 2013 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES2013.