Medicare Compliance & Reimbursement

Latest OIG reports indicate that these specialists aren't performing all included E/Ms.

You probably know that global surgical fees include a set number of E/M services that are bundled into each surgery. But what you may not know is that the government keeps tabs on how many of those E/Ms you actually perform -- and if you don't provide the E/M services, Medicare can cut them from the package -- and decrease your surgical fees.

Two recent OIG audits reveal that cardiovascular and musculoskeletal surgeons are vastly underperforming the E/M services included in surgical packages, but are collecting the entire global fee. This means that Medicare is overpaying these doctors for their surgeries.

Cardiovascular surgery: The OIG sampled 300 global surgeries and found that in 132 of them, the physicians provided fewer E/M services than were included in the global package, meaning that they technically collected more than they should have for the service.

On the flip side, in 70 cases, cardiologists provided more E/M visits than were included in the global fee, meaning those physicians actually provided some of their services for free.

Musculoskeletal surgery: The OIG also sampled 300 musculoskeletal surgeries and found that physicians provided fewer E/M services than were included in 165 global fees, meaning that more than half of these physicians were paid full global fees even though they did not perform all of the allotted E/M services.

In contrast, in 46 cases, musculoskeletal surgeons performed more E/M services than what was included in the global package.

Outcome: Based on these reports, the OIG recommended that CMS should adjust the number of E/M services in global packages. This would reduce payments to cardiovascular surgeons by about $14.6 million and would cut musculoskeletal surgery payments by $49 million, the reports indicate.

Resource: To read the cardiology report, visit http://go.usa.gov/Vyu. For the musculoskeletal surgery report, visit http://go.usa.gov/Vyz.