ACE Alert, October 7, 2021 Volume 41
OIG $636 MILLION
Recently the OIG issued an audit finding regarding the implantation of neurostimulator devices. Since many of our clients either perform the implantation or provide anesthesia for the procedure, we thought this was worth bringing to your attention. It is good to remember that ancillary services for procedures deemed not medically necessary are subject to recoupment.
Below is the OIG report Information:
Medicare Overpaid $636 Million for
Neurostimulator Implantation Surgeries
“More than 40 percent of the health care providers covered by our audit did not comply with Medicare requirements when they billed for neurostimulator implantation surgeries. We determined that medical records for 48 of the sampled beneficiaries (associated with 46 providers) did not contain support that providers met Medicare requirements. On the basis of our sample results, we estimated that during calendar years 2016 and 2017 providers received $636 million in unallowable Medicare payments associated with neurostimulator implantation surgeries and beneficiaries paid $54 million in related unnecessary copays and deductibles. These unallowable payments occurred because providers did not include sufficient documentation in the medical records to support that Medicare coverage requirements were met. Furthermore, claims for neurostimulator implantation surgeries did not require prior authorization and are not subject to prepayment review. During our audit, the Centers for Medicare and Medicaid Services published a final rule that requires prior authorizations for implanted spinal neurostimulators; however, this rule does not include claims for Parkinson’s disease or seizure disorders”.
Read the Summary
Read the Full Report
Groups are advised to pull the LCD policies in their jurisdiction and do focused medical necessity reviews to ensure that your providers are documenting all required elements.
If we can help in any way, please give us a call at 913-648-8572.