Review of the Services Related to the Placement of Arterial Stents

EXECUTIVE SUMMARY:

>Our audit objective was to determine whether 72 paid Medicare claims for outpatient stent placement services provided in calendar year 2002 were reasonable, necessary, and allowable under Medicare rules; supported by adequate documentation; and properly coded.  The Program Safeguard Contractor found that a total of 20 claims from 15 providers did not meet Medicare reimbursement of requirements and, as a result, were overpaid by a total of $35,291.  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.  In addition, the providers may need additional education covering proper billing practices for stent services.  We recommended that TrailBlazer recover the $35,291 in overpayments and provide education to these providers to ensure that the claims they submit for reimbursement meet Medicare's requirements.  TrailBlazer generally agreed with our findings and recommendations, stating that it had recovered the overpayments based on our recommendations.