AMA Clinical Examples in Radiology - 2009 Bulletin 1
Facet Joint Injection Payments to be Audited
Facet Joint Injection Payments to be Audited The Centers for Medicare and Medicaid Services (CMS) instructed contractors to review facet joint claims data for services performed in the office setting. This instruction was released by the CMS based on the Office of Inspector General (OIG) report, which reveals that 63 percent of the facet joint injection services allowed in 2006 did not meet Medicare requirements and, as a result, $96 million in improper payments were made to physician services. Furthermore, the report points out that $33 million in improper payments were allowed for associated facility claims. The OIG report...
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Article Overview
This short article explains a CMS instruction tied to an OIG report about facet joint injection claims in the office setting. It is relevant to billing, coding, compliance, and audit-focused readers who want a high-level view of the documentation, coding, and payment integrity concerns discussed in the notice. The article also points readers to related CMS and OIG materials for additional context.
Why This Topic Matters
It highlights a Medicare payment integrity issue affecting facet joint injection services and signals increased contractor review activity. Readers in coding and compliance can use it to understand the broader audit environment and the type of guidance CMS issued in response to reported billing problems.
What You Will Learn
- The general Medicare audit context surrounding facet joint injection claims
- Why documentation and coding issues were flagged in the referenced review
- What kinds of contractor review and education activity were instructed by CMS
- Where the article directs readers for additional CMS and OIG information
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practice administrators
- Radiology revenue cycle teams
- Audit and integrity professionals
Modifiers Discussed
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