Increase in Medicare spending for sleep studies

[djr1215]

Each year the OIG publishes a Work Plan for the following year - a list of activities they are going to be investigating/reviewing. The 2011 plan was released today with 2 items of interest to some on this forum (notice the increase in payments for polysomnography):
Appropriateness of Medicare Payments for Polysomnography
We will review the appropriateness of Medicare payments for sleep studies. Sleep studies are reimbursable for patients who have symptoms consistent with sleep apnea, narcolepsy, impotence, or parasomnia in accordance with the CMS Medicare Benefit Policy Manual, Pub. No. 102, ch. 15, § 70. Medicare payments for polysomnography increased from $62 million in 2001 to $235 million in 2009, and coverage was also recently expanded. We will also examine the factors contributing to the rise in Medicare payments for sleep studies and assess provider compliance with Federal program requirements.
(OEI; 00‐00‐00000; expected issue date: FY 2012; new start)

Medicare Payments for Sleep Testing
We will review the appropriateness of Medicare payments for sleep test procedures provided at sleep disorder clinics. The Social Security Act, § 1862(a)(1)(A), provides that Medicare will not pay for items or services that are “not reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the functioning of a malformed body member.” CMS’s Medicare Benefit Policy Manual, Pub. No. 100‐02, ch. 15, § 70, provides CMS’s requirements for coverage of sleep tests under Part B. A preliminary OIG review identified improper payments when certain modifiers are not reported with sleep test procedures. We will examine Medicare payments to physicians and independent diagnostic testing facilities for sleep test procedures to determine whether they were in accordance with Medicare requirements.
(OAS; W‐00‐10‐35521; W‐00‐11‐35521; various reviews; expected issue date: FY 2011; work in progress)

[Slinky]

Symptoms of impotence justify reimbursement for a sleep study???