OIG Releases Report on Inappropriate Billing for Pain Management in Spine Care

Members & Publications


November 2, 2020

On October 13, the Office of the Inspector General (OIG) released a new report detailing a recent audit of spinal facet joint injections.

The described goal of this audit was to identify injection sessions exceeding the Medicare coverage limitation, which, in most Medicare jurisdictions, is a maximum of five sessions during a rolling 12-month period.  The audit was conducted on claims from 2017-2019 and a total of $748,555 in improper payments was identified. The Centers for Medicare & Medicaid Services (CMS) agreed with the OIG’s recommendation to recover these funds. CMS also agreed to explore strategies for improved oversight and claims review to decrease improper payments for injections in excess of the approved maximum five session. 

However, CMS also noted in its response to this audit, that the improper payments represent less than 0.1% of the overall payments made under the Medicare Physician Fee Schedule during the time of the audit. Further, CMS noted that a large portion of the improper payments were made due to an issue with the existing Fraud Prevention System, which has since been corrected. 

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.