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US stent billing at Medicare still under audit

This article was originally published in Clinica

Executive Summary

US auditors say they are continuing to investigate whether hospitals and physicians are appropriately billing Medicare for coronary stenting procedures. They intend to release their findings in fiscal year 2005, which began on October 1. The US inspector general (IG) assigned to the Health and Human Services department first disclosed plans for the study in October 2003, with a tentative release date sometime in fiscal 2004. But the IG's recently released 2005 "workplan" now sets the timetable for release in this fiscal year. A portion of the investigation looks at whether multiple procedures performed during a single visit to the cath lab should be billed as a single procedure. Another pending study looks at whether hospitals are mistakenly billing Medicare for laboratory services performed for patients with renal disease. Medicare pays a composite rate for dialysis that is supposed to include laboratory services, the IG's office said. The study is overdue. It was supposed to be released in 2004. Also ahead this year is a report on payments for nerve conduction studies - electrodiagnostic tests of the integrity of the peripheral nerves. Medicare-allowed amounts for these studies went from $136m in 2000 to $186m in 2001 - or a 37% increase.

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