Medicare Part B Payments for Radiology Services Provided During Inpatient Stays: 2001 Through 2003

EXECUTIVE SUMMARY:

Our objective was to determine whether carriers made inappropriate Part B payments for outpatient radiology services provided to Medicare beneficiaries during inpatient stays at prospective payment system (PPS) hospitals.  During calendar years 2001'2003, carriers inappropriately made Part B payments for 100,034 outpatient radiology services provided to PPS hospital inpatients.  Rather than billing the hospitals for these services, radiology suppliers billed the carriers and received separate payments.

We recommended that CMS:  (1) instruct the Medicare carriers to recover the $20 million in potential overpayments identified in our review and monitor the recovery of those overpayments, (2) establish prepayment controls to detect and prevent separate payments for Medicare Part B radiology services provided to beneficiaries during inpatient stays in PPS hospitals and/or develop postpayment review procedures to identify suppliers that submit and receive payments for inappropriate billings, and (3) alert the Medicare carriers to the most common types of payment errors and help them educate radiology suppliers about such improper billings.  CMS generally agreed with our recommendations.

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