Healthcare News & Insights

Medicare wants back $38M it paid to emergency departments

Oops! Medicare says it wrongly paid more then $38 million in claims for outpatient emergency department  radiological services — and it wants its cash back.

A new report (pdf) by the Office of the Inspector General (OIG) says that in 2008, 33% of Medicare claims from EDs for CT, MRI and similar services didn’t have the proper documentation and shouldn’t have been paid.

Medicare requires that claims include both the physicians orders be in the medical record documentation and that there’s supporting documentation that the interpretation and reports were performed.

The OIG said inconsistent payment guidance was part of the problem, and recommended that Medicare adopt a more uniform policy.

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