AANEM is dedicated to helping stop fraud and abuse in EDX medicine and has created several resources to assist payers and investigators to identify potential fraud and assist in making sure patients receive quality care. View AANEM resources aimed at assisting in such investigations:
Anti-Fraud Position Statements
What Does ‘On Site’ and ‘Real Time’ Mean?
Defines the terms “on site” and “real time” as used in the AMA’s CPT codebook for nerve conduction studies. Can be utilized to combat fraud and abuse by providers that are not providing the quality of care required to bill the codes.
Proper Performance and Interpretation of Electrodiagnostic (EDX) Studies
Explains that a properly trained physician should perform (or, in the case of NCS, at least supervise) and interpret nerve conduction study (NCS) and needle EMG data on site and in real time. Additionally, in the majority of situations, both a needle EMG and NCS should be performed together.
Who is Qualified to Practice Electrodiagnostic Medicine?
Describes qualifications of EDX providers – for both needle EMGs and nerve conduction studies (NCS).
Recommended Policy for Electrodiagnostic Medicine
Contains recommendations which can be used in developing and revising current reimbursement guidelines.
Model Policy for Needle EMG and NCSs
Describes a typical EDX examination, when EDX testing is indicated, explains the performance of the tests with reference to the CPT codes, the limitations of the studies, the maximum number of tests needed in 90% of cases, timing of testing after an injury, and frequency of testing.
Electrodiagnostic Medicine: Pay for Quality
Explains how a value-based reimbursement system for properly-performed EDX testing and assessment of a patient will increase the value of each healthcare dollar spent.
Mobile Laboratories Provide Substandard Patient Care
Describes characteristics of substandard care in EDX medicine and explains proper standards of care.
If you are investigating potential fraud or abuse in EDX medicine, please consider reaching out to the AANEM policy department with any questions or concerns: firstname.lastname@example.org