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.