This month, the Office of Inspector General of the Department of Health and Human Services released a new report detailing the results of an audit conducted on claims for spinal facet-joint denervation sessions. The audit, conducted on claims from January 2019 through August 2020, found that Medicare Administrative Contractors (MACs) were regularly paying claims for denervation sessions that exceeded the maximum number of sessions allowed based on medical policy. While policies vary somewhat from jurisdiction to jurisdiction, there are limits to the number of sessions each beneficiary can receive during a 12-month period. In total, the audit found that Medicare improperly paid physicians $9.5 million. Based on these findings, the OIG has made several recommendations to the Centers for Medicare & Medicaid Services (CMS). Recommendations include recoupment of improper payments, assessment of the MACs’ ability to identify improper payments based on the number of sessions provided and direction to the MACs that they review claims after the audit period to identify similar issues. CMS reviewed the OIG’s report and concurred with the OIG’s recommendations.
Members who bill for spinal facet-joint denervation are encouraged to review the report and review their jurisdiction’s medical policy for details on session limits. Providers identified as having been improperly paid in the OIG audit may be contacted for recoupment of funds.