Based on a recent report from the US Department of Health & Human Services Office of Inspector General (OIG), more than 40 percent of the health care providers covered by the audit did not comply with Medicare requirements when they billed for neurostimulator implantation surgeries.
On the basis of the sample results, it is estimated that during calendar years 2016 and 2017 providers received $636 million in unallowable Medicare payments associated with neurostimulator implantation surgeries and beneficiaries paid $54 million in related unnecessary copays and deductibles. These unallowable payments occurred because providers did not include sufficient documentation in the medical records to support that Medicare coverage requirements were met.
Furthermore, claims for neurostimulator implantation surgeries did not require prior authorization and are not subject to prepayment review. During its audit, CMS published a final rule that requires prior authorizations for spinal neurostimulators implanted in the outpatient hospital setting; however, this rule does not include claims for Parkinson’s disease or seizure disorders.
NASS urges members to be aware that they may be contacted by their MAC to return overpayments made during the review period.
For information on the OIG recommendations and CMS’ comments from the US Dept. of Health & Human Services Office of Inspector General (OIG) Report, please visit: https://oig.hhs.gov/oas/reports/region1/11800500.asp