Review of the Services Related to the Placement of Arterial Stents

EXECUTIVE SUMMARY:

Our audit objective was to determine whether 28 paid Medicare claims processed by Mutual of Omaha (Mutual) in Texas for outpatient stent-placement services provided in calendar year 2002 were:  (1) reasonable, necessary, and allowable under Medicare rules; and (2) properly coded.  We found that a total of 2 claims from 2 providers were overpaid by a total of $4,109.  These errors may have occurred because the providers did not have procedures in place to ensure that the services for which they billed met Medicare requirements.  We recommended that Mutual recover the $4,109 of overpayments and provide education to these providers to ensure that the claims they submit for reimbursement meet Medicare's requirements.  Mutual generally agreed with our findings and recommendations, but did not agree that one of the Healthcare Common Procedure Codes should be denied.