CMS overpaid providers $636M for neurostimulator surgeries: OIG

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CMS should recoup $636 million in overpayments to hospitals and other providers from the improper billing of neurostimulator implantation surgeries, according to HHS' Office of the Inspector General.

An audit from the OIG found that more than 40 percent of healthcare providers didn't comply with Medicare requirements when billing for neurostimulator implantation surgeries.

The OIG audit covered $1.4 billion in Medicare payments to providers for 58,213 beneficiaries who had a neurostimulator implant surgery from 2016-17. The OIG randomly selected a sample of claims from 106 beneficiaries submitted by 102 providers. 

The OIG found that the medical records of 48 beneficiaries, associated with 46 providers, did not meet Medicare billing requirements. 

Based on the sample, the OIG estimates that providers received $636 million in improper payments for these surgeries. 

"These unallowable payments occurred because providers did not include sufficient documentation in the medical records to support that Medicare coverage requirements were met," the OIG said. 

The OIG added that CMS published a final rule while it was conducting the audit that requires prior authorizations for implanted spinal neurostimulators but that the rule does not require them for claims related to Parkinson’s disease or seizure disorders.

The OIG is recommending that CMS notify providers with potential overpayments to identify, report and return any overpayments, that CMS conduct provider outreach on Medicare coverage requirements for the surgeries, and add more prior authorization requirements for claims related to Parkinson's disease or seizure disorders. 

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