Medicare Compliance & Reimbursement

OIG also looking into incident-to billing, polysomnography

Heads up: If your practice owns an MRI or other imaging scanner, you soon could be in for an even bumpier ride.

Medicare has already taken steps to crack down on physician ownership of diagnostic imaging. But now two different watchdogs are studying your arrangements--and the result could be more crackdowns.

The HHS Office of Inspector General (OIG) has three different reports on imaging in the pipeline. One deals with diagnostic x-rays in hospital Emergency Departments, which increased 9.6 percent from 2001 to 2004.

Another report will examine geographic areas that have high ultrasound service use to see if those extra ultrasounds are really necessary. And a third report will look at the business relationships of physicians who provide Magnetic Resonance Imaging (MRI) scans to see if those arrangements lead to more use.

More scrutiny: The Medicare Payment Advisory Commission plans a study to figure out if "physicians' financial incentives are related to increased use of imaging services," according to testimony at its Oct. 3 meeting. MedPAC is also concerned about physician ownership of other services, including Ambulatory Surgical Centers. But the skyrocketing cost of imaging scans has MedPAC especially worried.

More OIG reports: The OIG has it in for doctors, judging from its 2008 Work Plan. The OIG wants to look at reassignment of benefits to see if there are any problems with doctors reassigning their payments to billing companies.

The OIG is also launching a new study of some unspecified physician services to see if Medicare paid for them appropriately. And the OIG wants to look into polysomnography services and long-distance physician services related to home health agencies or skilled nursing facilities.

Also, the OIG is continuing to work on reports on incident-to services and doctors listing the wrong Place of Service (POS) on claims.

Note: The OIG Work Plan is online at http://oig.hhs.gov/08/Work_Plan_FY_2008.pdf.