Inspector general eyes radiology ER payments, equipment utilization

Payments for equipment utilization and the appropriateness of many emergency department scans will come under review by the Office of Inspector General under a fiscal year 2010 work plan.

Every year the U.S. Department Health and Human Services Office of Inspector General (OIG) lists healthcare arrangements it believes cost too much or could violate federal fraud and abuse laws. Included in the 2010 OIG review is a look at the appropriateness of payments for x-rays performed in emergency departments.

OIG will also look at whether Medicare Part B payments reflect the actual expenses incurred by physicians and whether the utilization rate reflects current industry practices.

The Radiology Business Management Association recently published a study confirming actual equipment utilization is 54%, which is below the 75% called for in healthcare reform legislation from the House of Representatives.

Other projects include an ongoing examination of services and billing patterns in locations with a high density of independent diagnostic testing facilities.

"ACR members who render patient care in the areas listed in the work plan should not expect an immediate knock on their office door from the OIG," a press release from the American College of Radiology said. "However, it could happen, and to be prepared, radiologists and their staffs should properly document the medical necessity of and correct code for their services." Key elements of the work plan:

• Under "Medicare Payments for Part B Imaging Services," the plan states, "For selected imaging services, we will focus on the practice expense components, including the equipment utilization rate. We will determine whether Medicare payment reflects the actual expenses incurred and whether the utilization rate reflects current industry practices."

• Under "Payments for Diagnostic X Rays in Hospital Emergency Departments," the plan states, "We will review a sample of Medicare Part B paid claims and medical records for diagnostic x-rays performed in hospital emergency departments to determine the appropriateness of payments. … The Medicare Payment Advisory Commission (MedPAC), in its March 2005 testimony before Congress, reported concerns regarding the increasing cost of imaging services for Medicare beneficiaries and potential overuse of diagnostic imaging services. In 2007, Medicare reimbursed physicians approximately $207 million for imaging interpretations performed in emergency departments. We will determine the appropriateness of payments for diagnostic x-rays and interpretations."