Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Pathology Services Claimed by Urology Tyler, P.A. Tyler, Texas From May Through December 2004," (A-05-05-00037)

June 28, 2007


PDF FileComplete Text of Report is available in PDF format (1.69 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

The objectives of our review were to (1) determine whether Urology Tyler (the Practice) claimed reimbursement for pathology laboratory services in accordance with Medicare Part B medical necessity and documentation requirements from May through December 2004 and (2) analyze the Practice’s utilization patterns for pathology services.  The Practice’s claims for pathology laboratory services generally complied with Medicare Part B medical necessity and documentation requirements.  We identified one exception that was improperly billed and paid due to a clerical error, which was corrected during our audit.  We noted an increase in the number of prostate-related pathology services requested and performed after the Practice opened its own laboratory.  In addition, the Medicare carrier reimbursed the Practice for more units per claim, on average, than it reimbursed other providers for the same pathology service.  This report contains no recommendations.