OIG: Mississippi-based Hospital Overcharged Medicare $67k for Polysomnography Services

To determine whether Medicare claims that North Mississippi submitted for polysomnography services complied with Medicare requirements, the OIG reviewed a stratified random sample of 100 beneficiaries who received polysomnography services between January 2017 and December 2018.

A version of this article was first published March 29, 2021, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

North Mississippi Medical Center (North Mississippi) submitted Medicare claims for polysomnography services that did not comply with Medicare billing requirements, resulting in an estimated $67,038 in overpayments for polysomnography services submitted over a two-year period, according to a recent Office of Inspector General (OIG) report.

Previous OIG audits of polysomnography services (i.e., diagnostic sleep study services) found that Medicare paid for some services that did not meet Medicare billing requirements. Specifically, Medicare paid for services that were billed with inappropriate diagnosis codes and without required supporting documentation. The results of these previous audits prompted the OIG to conduct additional audits for polysomnography services.

To determine whether Medicare claims that North Mississippi submitted for polysomnography services complied with Medicare requirements, the OIG reviewed a stratified random sample of 100 beneficiaries who received polysomnography services between January 2017 and December 2018. The audit focused on CPT codes 95810 (polysomnography; age six years or older, sleep staging with four or more additional parameters of sleep, attended by a technologist) and 95811 (polysomnography; age six years or older, sleep staging with four or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist).

The OIG found that North Mississippi submitted Medicare claims for polysomnography services that complied with Medicare billing requirements for 88 of the 100 beneficiaries. Medicare claims for the remaining 12 beneficiaries did not comply with Medicare requirements, resulting in overpayments of $7,624. On the basis of the sample results, the OIG estimates that North Mississippi received overpayments of at least $67,038 for polysomnography services provided during the audit period.

The OIG recommends that North Mississippi Medical Center:

• Refund to the Medicare program the estimated $67,038 in overpayments for polysomnography services submitted during the audit period
• Educate its staff on properly billing for polysomnography services
• Revise policies and procedures to ensure that claims for these services are coded and billed correctly