OIG: Medicare overpaid for PSG services

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Thursday, June 20, 2019

WASHINGTON – Medicare made payments to providers for polysomnography services that did meet billing requirements, according to a new report from the Office of Inspector General.

Of 200 randomly selected Medicare beneficiaries, payments were made for 117 that met billing requirements with 276 corresponding lines of services, and for 83 that did not meet requirements with 150 corresponding lines of services, resulting in net overpayments of $56,668, according to the OIG. Based on the sample results, the agency estimates Medicare made overpayments of $269 million for polysomnography services during the audit period.

The OIG recommends that CMS instruct the MACs to recover the portion of the $56,668 in overpayments that are within the four-year reopening period. It also recommends that CMS work with the MACs to conduct data analysis that allows for targeted reviews for polysomnogrpahy services and for educating providers on proper billing.

CMS concurred with the recommendations.