AMA Clinical Examples in Radiology - 2009 Bulletin 2
Office of the Inspector General (OIG) Recommends the Centers for Medicare & Medicaid Services (CMS) Review Ultrasound Claims
Office of the Inspector General (OIG) Recommends the Centers for Medicare & Medicaid Services (CMS) Review Ultrasound Claims In an OIG Draft Report on Medicare Part B Billing for ultrasound (OEI-01-08- 00100 ) (available at http://oig.hhs.gov/oei/reports/oei-01-08-00100.pdf ), it was recommended that the CMS monitor ultrasound claims-data to detect questionable claims and take action when providers bill for high numbers of questionable ultrasound services. In response, the CMS issued Transmittal 574 to instruct contractors (Medicare Administrative Contractors (MACs) and Fiscal Intermediaries (FIs) to review claim data to prevent improper payments as advised by the recent OIG reports...
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Article Overview
This article covers an OIG draft report on Medicare Part B ultrasound billing, CMS Transmittal 574, and the broader program-integrity response to potentially questionable ultrasound claims. It is relevant to radiology practices, coders, billing staff, compliance teams, and Medicare contractors who need to understand the general scope of the review, the types of claim patterns discussed, and the supporting coding and documentation resources referenced by the article.
Why This Topic Matters
It helps readers understand why ultrasound claims drew federal scrutiny, how CMS directed contractors to review claims data, and what kinds of documentation and coding reference materials were highlighted in response.
Article Sections
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OIG draft report and CMS response
Summarizes the OIG report, the CMS transmittal, and the role of Medicare contractors and recovery audit activities in claim review. The section focuses on the overall program-integrity response and the types of review actions discussed.
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Findings from the 2007 claims review
Describes the national claims analysis and the geographic distribution of the reviewed claim volume. It provides the broad context for the ultrasound billing patterns discussed in the article.
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Characteristics associated with questionable ultrasound claims
Outlines the categories of claim features the OIG associated with potentially questionable billing patterns. The section is centered on claim-data indicators and ordering-provider information.
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Examples of reviewed ultrasound procedure combinations
Identifies selected ultrasound procedure pairings and related billing patterns referenced in the claims review. It also notes the discussion of a procedure reported for adult patients.
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Related coding resources and references
Lists the coding publications, organizational resources, and transmittal reference materials cited as background and support. This section is oriented toward further reference rather than claim analysis.
What You Will Learn
- How the article frames the OIG review of ultrasound claims
- What broad claim patterns were discussed in connection with Medicare oversight
- Which general categories of documentation and ordering information were emphasized
- What supporting coding resources were referenced for ultrasound billing education
- How CMS and Medicare contractors were described as responding to the report
Who Should Read This
- Radiology coders
- Medical billing staff
- Compliance professionals
- Radiology practice managers
- Medicare contractors
- Physicians ordering imaging services
Codes Discussed
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