Medical Imaging in the ED – Problems With Medicare


Medical imaging in the emergency department“Medicare paid $38 million in erroneously documented imaging claims.” That’s the headline of a recent article. That’s a lot medical imaging mismanagement.

That dollar amount is based on substantial data. The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) analyzed around 9.6 million claims before concluding that 19 percent of outpatient CTs and MRIs and 14 percent of outpatient x-rays at Emergency Departments (EDs) around the country were improperly documented.

The two most common documentation errors were 1) A lack of a physician’s order for the medical imaging and 2) Analysis of medical imaging after the patient had left the ED.

What’s not clear is how many of those medical images would still have been approved for payment if the documentation had been proper.

OIG basically concluded that the problem – and therefore the solution – is two-pronged:

  • EDs have to improve their documentation procedures. This is not a mere technicality. A physician’s approval indicates that a trained medical professional thinks that some kind of medical imaging would be beneficial. Medical imaging is expensive, so it shouldn’t be used  haphazardly.
  • CMS needs to clarify its medical imaging interpretation rules. It turns out that many EDs have been interpreting images after patients leave for some time and that CMS hasn’t let that be a barrier to payment. The reasons for “delayed interpretation” are many: patients who aren’t in serious condition leave the ED and are willing to wait at home for medical imaging results, EDs are understaffed, radiologists and other medical imaging professionals are not as available during the hours when EDs are busiest, and so on.

CMS accepted the OIG’s recommendation that it clarify ED medical imaging documentation requirements. We’ll see if healthcare systems improve their own internal procedures to prevent unnecessary medical imaging and ensure proper documentation of medical imaging procedures.

Learn more about McKesson Medical Imaging solutions that improve the communication between the emergency department and radiology

Leave a Reply