Medicare incorrectly dished out $6.7 billion too much for claims for evaluation and management (E/M) services in 2010, which represents 21 percent of the $32.3 billion spent on E/M services that year, according to a new report released this week from the Office of Inspector General.
In the review, the OIG looked at a random sample of 657 Part B claims for E/M services from 2010 and asked professional coders to determine if the charged rates matched up with the records.
"The natural question that comes out of this is: Are these physicians billing appropriately?" Dwayne Grant, regional inspector general for evaluation and inspections in the Atlanta region who oversaw the new report, told ProPublica. "We don't want to pay them too much but we don't want to pay them too little either."
What's more, the OIG found 42 percent of claims for E/M services in 2010 were incorrectly coded, while 19 percent lacked documentation. The OIG also concluded that high-coding physicians incorrectly coded claims more often than other physicians, according to the report.
Given the inappropriate spending on E/M services, the OIG recommends the Centers for Medicare and Medicaid Services educate physicians on coding and documentation requirements for E/M services, as well as on how to determine the level of a service and which documentation is needed. The OIG also encourages CMS contractors to focus on claims reviews from high-coding physicians to identify improper billing.
While CMS agreed with the OIG's education recommendation, it disagreed with the recommendation to review claims from high-coding physicians, claiming it isn't cost effective to do so.
Meanwhile, a recent review of Medicare data found more than 1,800 healthcare professionals billed Medicare for the most expensive type of doctor visit, an E/M service, at least 90 percent of the time. What's more, more than 1,200 physicians out of 329,500 billed exclusively at the highest level, FierceHealthPayer previsouly reported.