Outpatient Facility Coding Alert - 2009 Issue 25
COMPLIANCE: 20 Percent of Ultrasound Claims 'Raise Concerns,' OIG Says
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Article Overview
This article summarizes an OIG audit of Medicare Part B ultrasound claims and explains why the findings matter for compliance monitoring. It covers general billing-pattern concerns, ordering-physician claim history issues, geographic patterns of high ultrasound use, and the likelihood of further review by program integrity contractors. The piece is aimed at coders, compliance staff, and providers who monitor diagnostic imaging billing.
Why This Topic Matters
It flags a federal audit finding involving ultrasound claims and indicates that certain billing patterns and service areas may draw heightened scrutiny. Readers can use it to understand the compliance context around ultrasound billing and postpayment review risk.
What You Will Learn
- What the OIG audit examined in Medicare Part B ultrasound billing
- Why claim patterns can trigger compliance concerns
- How geographic concentration of ultrasound use factored into the audit
- Why the findings may lead to additional postpayment review activity
Who Should Read This
- Medical coders
- Compliance officers
- Physicians
- Billing staff
- Practice managers
- Revenue cycle professionals
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