The OIG report is based on analysis of 2011 polysomnography service claims from both hospital outpatient departments and nonhospital providers. Researchers identified the claims that did not meet Medicare requirements, along with the providers whose billing was deemed questionable using criteria from Medicare and outside sleep medicine professionals.
The OIG discovered $17 million in improper billings, mainly comprised of claims with the wrong diagnosis codes. The vast majority of claims with inappropriate diagnosis codes (85 percent) came from hospitals. The investigation also revealed 180 providers that exhibited patterns of questionable billing for polysomnography services. Most of these providers submitted reimbursement claims for a patient with another polysomnography claim on the same day, which is questionable as polysomnography services require an overnight stay and cannot happen more than once per day.
More Articles on the OIG:
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