Medicare Audits for Chest X-Rays

Last year we informed members of an audit being performed by Palmetto Medical Review in California on claims paid for chest x-rays, CPT 71010 and 71020, in both northern and southern California. We had contacted Palmetto after receiving complaints from some groups about the high volume of letters requesting documentation of medical necessity, and the difficulty of providing the same for hospital inpatients where the hospital would have the records and not the radiology group who billed the professional component.

Click here to view the article that has been sent for posting to the J1 Part B website as notification of the current results of the service specific complex edit for Radiology services in northern and southern California.

As you can see, it outlines the results of their audits and concludes that this auditing will continue in southern California. Radiology groups billing for these services should review the article and be aware of the potential for receiving inquiries on paid claims.

Medi-Cal Notice on Reductions in Radiology Reimbursement

DHCS published an announcement in their Provider Bulletin on 12/31/10 announcing the change to Medi-Cal radiology reimbursement to be no more then 80% of the average Medicare allowable in California. Click here for a link to the article.

The rate changes will not be posted on the Medi-Cal website until 1/15/11 but they are retroactive to 10/1/10 and will result in money being taken from future Medi-Cal check writes to recoup any over payments. The reductions are dramatic for CT, MRI and PET. The CRS is pursing legal action and we encourage members to contribute to our Legal Fund. Here is a link to the background and how to contribute. Click here