Inspector general: CMS overpaid hospitals by nearly $25M for radiation therapy planning

CMS handed out $25 million more in Medicare payments to hospitals for specific radiation therapy planning services than was appropriate, according to an Office of the Inspector General (OIG) report.

From 2013 to 2015, Medicare’s intensity-modulated radiation planning services (IMRT) bundled payments totalling $109.2 million. Approximately 1,200 hospitals billed Medicare nearly $25 million more for services that were already included in bundled payments. However, the OIG estimated an additional $5.4 million in overpayment may have occurred in the two years following its audit period.

During the planning stage of IMRT, physicians use imaging, calculations and simulations to plan out radiation therapy. According to the report, most overbilling involved complex imaging simulations.

The report findings attributed the mistake to “unfamiliar” or “misinterpreted” understanding of CMS guidance on part of the hospitals.

“In addition, the claim processing edits did not prevent the overpayments because the edits applied only to services billed on the same date of service as the billing of the procedure code for the bundled payment, and the services in our sample were billed on a different date of service,” the report read.

The OIG recommended CMS institute an edit for IMRT planning services billed up to 14 days before the procedure code for the bundled payment is actually billed. The measure could have saved up to $25 million during the audit period, according to the report. Additionally, CMS should work with Medicare contractors to better educate hospitals on proper billing.