CMS’s guidance on payment for interpretation of diagnostic tests furnished to emergency room patients offers inconsistent direction regarding whether interpretations are payable only if they were performed while patients were in the emergency room.
According to CMS guidance, if claims processing contractors receive multiple billing claims from, for example, the emergency room physician and the radiologist, contractors are to pay only for the interpretation performed “at the same time” as the diagnosis and treatment of the beneficiary in the emergency room. However, if only one claim is received, contractors are not required to confirm that the interpretation was performed while the beneficiary was in the emergency department.
hysicians’ orders were not present in medical record documentation for 12 percent of CT and MRI claims and 9 percent of x-ray claims Medicare allowed almost $18 million for interpretation and report claims of CTs and MRIs not supported by documented physicians’ orders. Medicare allowed $5 million for interpretation and report claims of x-rays that did not have documented physicians’ orders. As a condition for Medicare payment for these services, medical records must include documented physicians’ orders.
Documentation was not provided to support that interpretation and reports were performed for 12 percent of CT and MRI claims and 8 percent of x-ray claims
Medicare allowed almost $19 million for undocumented interpretation and reports of CTs and MRIs. Medicare allowed $5 million for undocumented interpretation and reports of x-rays. The Act states that as a condition for Medicare payment, providers must furnish appropriate information about the service (i.e., documentation to support that the service was performed).
In 2008, Medicare paid for interpretation and reports performed for 16 percent of x-rays and 12 percent of CTs and MRIs after beneficiaries left emergency departments