The Department of Health & Human Services' Office of Inspector General (OIG) has turned up evidence of tens of millions of dollars worth of payment errors in connection with Medicare's handling of claims for certain types of emergency room radiology services.

In 2008, Medicare erroneously allowed 19% ($29 million) of claims for interpretation and reports for computed tomography (CT) and magnetic resonance imaging (MRI) and 14% ($9 million) of claims for interpretation and reports for x-rays in hospital outpatient emergency departments because of insufficient documentation, the OIG finds. 

Of the allowed Medicare claims for CTs and MRIs in hospital outpatient emergency departments in 2008:

• 12% ($18 million) did not have physicians' orders as part of the medical record documentation, and
• 12% ($19 million) did not have documentation to support that interpretation and reports had been performed. 
• 5% ($7.3 million) had overlapping errors. 

Of the allowed Medicare claims for x-rays in hospital outpatient emergency departments in 2008:

• 8.6% ($5.5 million) did not have physicians' orders as part of the medical record documentation, and 
• 8.2% ($5.4 million) did not have documentation to support that interpretation and reports had been performed.  
• 3% ($1.9 million) of claims had overlapping errors.

Although not erroneously allowed, 12% ($19 million) of CT and MRI claims and 16% ($10 million) of x-ray claims were for interpretation and reports that were performed after beneficiaries left emergency departments, says the OIG. 

"The Centers for Medicare & Medicaid Services (CMS) offers inconsistent payment guidance on the timing for interpretation," the OIG says in its report.  "In 2008, approximately 71% of interpretation and reports for x-rays and 69% of interpretation and reports for CTs and MRIs did not follow one or more of the American College of Radiology-suggested documentation practice guidelines."