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Portable X-Ray Billing: What’s The Big Deal?

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Medicare paid $12.8 million in questionable reimbursements and $6.6 million in flatly incorrect reimbursements to portable X-ray suppliers in 2009, according to a study by inspector general of the federal Department of Health and Human Services.

The study, released this week, covered providers who travel to nursing facilities, private homes, and other nonclinical locations to provide X-rays of the extremities, pelvis, spine, skull, chest, and abdomen.

The inspector general found that 20 suppliers “exhibited questionable billing patterns.” Specifically, those suppliers billed Medicare for a total of $12.8 million for return trips to nursing facilities on the same day. Those payments may or may not have been legitimate. As the study said, “Claims data do not provide sufficient information to determine whether the supplier billed correctly for two separate trips to the facility or whether the supplier administered tests to the two beneficiaries during a single trip and incorrectly claimed full reimbursement of the transportation component for each beneficiary.”

The study found another $6.6 million in clearly incorrect payments. Medicare covers portable X-ray services only if they were ordered by a physician. The study found $4.3 million in payments for X-rays ordered by nurse practitioners, $1 million ordered by physician assistants, $900,000 ordered by podiatrists, and $400,000 ordered by registered nurses, chiropractors, and other nonphysicians.

The inspector general suggested that Medicare tighten its procedures, follow up on the questionable payments, and collect the $6.6 million in overpayments. The Centers for Medicare and Medicaid Services agreed.

So our government is trying to be more efficient and root out fraud. We applaud that. But couldn’t the inspector general more effectively use its resources by going after bigger fish?

Don’t get us wrong; we’re not in any way endorsing fraud or errors in Medicare payments. But Medicare paid about $225 million for portable X-ray services in 2009—out of total Medicare payments of $454 billion. That’s about five hundredths of 1 percent. Of the 352 suppliers of portable X-ray services that the inspector general studied, it found possible billing problems with only 20.

Frankly, this report seems to be, if anything, a vindication of the portable X-ray industry. When it comes to billing practices, the vast majority of suppliers seem to be following the rules.

Related seminar: Imaging Advances: Abdominal, Thoracic, Skeletal

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