Portable X-Ray Services

As a result of the Office of Inspector General (OIG) Report OEI-12-10-00190, Medicare contractors have been notified of questionable billing patterns of portable X-ray suppliers. The report focuses on several issues; however, contractors have been instructed to review previously paid claim data as far back as 2009. The referring provider information is being examined to determine if the service was referred by a doctor of medicine or doctor of osteopathy. Services not referred by a doctor of medicine or doctor of osteopathy are considered non-covered and overpayment collections will be initiated. The recovery efforts are being pursued under 42 CFR 405.980, which under subsection (b) allows contractors to reopen an initial determination up to four years after the initial determination when good cause is established. CMS maintain that the OIGís discovery of these claims provides good cause for the reopenings to determine overpayment potential. In addition to previously paid services being reviewed and overpayments collected, new claims submitted for these services which are not referred by a doctor of medicine or osteopathy will be denied.