AANEM News Express

AANEM News Express

Knowledge is Power: Educating Payers About EDX to Combat Fraud

6/4/2014
 
By Kate Penz, communications manager

“If your mother needed an electromyography (EMG), wouldn't you want someone who knew what they were doing to perform the test?,” Ronald C. Bingham, MD, asked his audience during a presentation at one of the National Healthcare Antifraud Association’s (NHCAA) National Education & Training Series (NETS) meetings held in Louisville, KY, on Wednesday, May 14. The program was on Detecting Fraud in Laboratory and Diagnostics Services. Dr. Bingham, a physiatrist from Tennessee and AANEM member, routinely speaks to insurance groups about the importance of accurate electrodiagnostic (EDX) studies in an attempt to build awareness and combat fraud and abuse in EDX medicine.

At this meeting, Dr. Bingham addressed approximately 60 special investigative unit professionals from insurance companies like Humana, CIGNA, and Medicare and Medicaid programs. He talked about common testing schemes related to EMGs and nerve conduction studies (NCSs), methods of identifying medically useless tests, and what to expect in the medical record.

“It is important to educate both laypeople and health care professionals—insurance companies, nursing associations, human resource managers, and physician groups—about the basics of electrodiagnostic medicine because many don’t understand the purpose it serves,” said Dr. Bingham.
 
To help explain the complex concepts Dr. Bingham started with a simple household analogy. “I told them that EDX physicians test the peripheral nervous system or ‘the wires’ in the body; we do not test the ‘circuit breaker box,’ meaning the brain. It helps illustrate the tests’ importance and why an expert is needed.”
 
“EMGs and NCSs are an extension of the patient’s medical history and exam and are pretty worthless if not performed by a qualified professional,” he continued. “I gave several examples of insurance company policies that clearly state EMGs must be performed by neurologists or physiatrists and new language to be adopted by Medicare Administrative Contractors that requires tests be done by neurologists or physiatrists.
 
“Unfortunately, our field is vulnerable to fraud and abuse. When I educate interested groups about the potential suffering and costs associated with poorly done test, they are very appreciative and want to know more.”
 
Dr. Bingham is board certified by the American Academy of Physical Medicine and Rehabilitation and the American Board of Electrodiagnostic Medicine. He has been a member of the AANEM for 20 years and operates an accredited EMG lab with four satellite clinics, which were granted exemplary status through the AANEM’s EDX Laboratory Accreditation Program.
 
“I am hopeful that presentations like this will help patients get the care they need,” concluded Dr. Bingham.
 
Coming up: AANEM Past-President Peter Grant, MD, has been invited to speak at the NHCAA NETS meeting focusing on Skills and Schemes for the Healthcare Fraud Investigator to be held August 12-14 in Phoenix, AZ. Dr. Grant will speak on fraud and abuse in EDX medicine to 150 law enforcement agents and insurance SIU investigators.

What are you doing to educate payers in your area? Send an email to policy@aanem.org to let us know.


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