Based on a recent report from the US Department of Health & Human Services Office of Inspector General (OIG), Medicare overpaid physicians for selected facet-joint denervation sessions in accordance with Medicare requirements. Specifically, for the audit period from January 2019-August 2020, the Medicare Administrative Contractors (MACs) for the 11 jurisdictions with a coverage limitation of 2 facet-joint denervation sessions per beneficiary for each covered spinal region during a 12-month period made improper payments of $7.2 million.
In addition, the MACs for the 9 jurisdictions with a coverage limitation of 4 facet joints per denervation session and the MACs for the remaining 3 jurisdictions with a coverage limitation of 10 facet joints per denervation session made improper payments of $2.3 million.
In total, Medicare improperly paid physicians $9.5 million. The OIG found that these improper payments occurred because the Centers for Medicare & Medicaid Services’ (CMS’) oversight was not adequate to prevent or detect improper payments for selected facet-joint denervation sessions. Therefore, the OIG has instructed CMS to recover the $9.5 million in overpayments and to evaluate its oversight mechanisms to prevent future improper payments for this procedure.
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/region9/92103002.asp