The denial of more than 150 Medicare reimbursement claims for audiology testing services was affirmed in a Jan. 10 federal district court ruling that held such services are only reimbursable when a treating physician has clearly requested the service beforehand (Doctors Testing Ctr., LLC II v. Sebelius, 2014 BL 6527, E.D. Ark., No. 4:11-cv-00857-KGB). The U.S. District Court for the Eastern District of Arkansas granted summary judgment to the Department of Health and Human Services on an appeal from a Medicare Appeals Council’s (MAC) decision to deny reimbursement of all of plaintiff Doctors Testing Center LLC II’s (DTC) claims. Judge Kristine G. Baker said in her decision that Medicare regulations require diagnostic tests of the type provided by the DTC to be requested by a physician prior to the performance of the test in order to be reimbursable. Baker said it was clear from the record that DTC’s technicians, not physicians, ordered the tests in the claims at issue and affirmed the MAC’s decision. Partial Claim Victory Reversed The DTC’s appeal centered on claims for diagnostic audiological testing services performed on Medicare beneficiaries in 2007. The DTC technicians ordered the tests for Medicare beneficiaries. The claims were denied reimbursement by…
