OBR OncologyCMS Projects $146 Million in Improper Oncology Payments

Oncologists were mentioned in two important specialist areas in CMS’ examination of inappropriate payments made to Part B providers, with the dismal outcomes as follows: Four hundred (400) claims for oncology/hematology were examined; of these, 60.9% lacked sufficient supporting paperwork, 31.9% had inaccurate coding, and the remaining cases had neither, along with no other issues. Given these findings, CMS projects $146 million in erroneous payments.

In medical oncology, 147 claims were analyzed; 54.5% had no documentation and 37.7% had inaccurate coding, with the balance (7.9%) having insufficient documentation. According to CMS data, the projected overpayments for this claim sample are $12.9 million.