Billing for Ultrasound Guidance of Pain Blocks Could Trigger an Audit
The Office of the Inspector General (OIG) is set to audit high volume ultrasound procedures. In 2007, 20 high-use counties accounted for 16% of Part B spending on ultrasound despite having only 6% of Medicare beneficiaries, the agency noted in a recent audit report. The services in these counties alone accounted for $336 million of the $2.1 billion in Part B spending on ultrasound services. Of the 20 counties in question, nine were in Florida; five in New York; three in New Jersey; and one each in Alabama, Michigan, and Texas.
The OIG noted that these counties had highly irregular ultrasound billing statistics when compared with the rest of the country. A group of 672 providers each billed 500 or more claims with questionable characteristics. These providers collectively billed over half a million such claims representing over $81 million in Part B charges in 2007. Lack of a service claim by the ordering doctor for treating the beneficiary was the most common of the questionable characteristics.
OIG is stressing that CMS take strong action to weed out fraud and abuse in these ultrasound cases, recommending that the agency closely monitor ultrasound claims, flag providers with questionable claims and/or high amount of services billed and even revoke the Medicare billing numbers of providers that CMS determines are filing fraudulent claims.
If you currently bill for Ultrasound guidance for pain blocks, you should review your compliance and billing policies to insure that you are following the letter of the law on these procedures. If you are receiving a high percentage of denials or rejected claims this is the first sign that you are not billing these correctly and you should seek qualified advice on these before the OIG come calling with an auditor in tow.
BCBS Louisiana Billing Guidlines to Change February 2, 2010
The following announcement has been posted in RED on the BCBS of Louisiana provider billing guidelines, online at: BCBS Louisiana’s Provider Manual.
Updated Billing Guidelines
Please note that new Anesthesia Billing Guidelines will be effective February 2, 2010. Providers will receive advanced notification of the new guidelines and this manual will be updated accordingly. BCBS Louisiana Provider Manual 2009 Rev1:3, page 42 of 92
It appears that BCBS of Louisiana is prepared to release new billing requirements even before they have completed the contracting with the state’s anesthesia providers. This is a risky proposition since most providers are anxiously awaiting the new contract rates and the proposed provider (MD/CRNA) spit by BCBS of Louisiana. In a recent email from Stacy Musgrove, BCBS Network Development, he indicated that BCBS has pushed back the mailing date for new BCBS anesthesia provider contracts from Juy 1 to August 1.
