OIG Releases Facet-Joint Injection Audit Results

Members & Publications

February 23, 2021

On February 19, the US Department of Health and Human Services Office of the Inspector General (OIG) released a report detailing results of an audit of payments made by Noridian Healthcare Solutions, LLC for spinal facet-joint injections.

The report documents payments made from January 2018 through May 2019. Results of a sampled 100 claims indicated that 51 claims did not comply with one or more of the Medicare coverage requirements for spinal facet-joint injections: amounting to $12,546 in improper payments.

Based on this sample, the OIG estimates that Noridian made improper payments exceeding $4 million during the sample window. Noridian has concurred with the results of the audit and agreed to collect the $12,546 in improper payments made to physicians from the sampled claims and will contact the affected physicians directly. Noridian has also agreed to conduct education regarding Medicare billing requirements. 


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.