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EMG
Often referred to as simply an EMG, this electrodiagnostic test has two components: a nerve conduction study (referred to as NCV or NCS) and a needle EMG. The quality of these exams depend on the training and integrity of the provider. As such, poor quality and fraudulent EMGs are common. Read on to learn why EMGs are vulnerable to fraud and abuse.
Nerve Conduction Study
(tests and records nerve activity)
Needle EMG
(tests and records muscle activity)
Take a dive with an interactive presentation and learn how deep EMG fraud goes and the steps you can take to get ahead.
Take a dive with an interactive presentation and learn how deep EMG fraud goes and the steps you can take to get ahead.
Why Does EMG Fraud Exist?
- Inexpensive equipment allows easy entry into the field.
- No training requirements-any licensed physician can lawfully perform studies.
- Lack of quality control reviews by carriers.
- The nature of the test-the only objective evidence occurs in the room with the patient.
What’s The Impact?
- Fraudulent providers cost the industry millions each year by driving up claims costs and making carriers pay for exams that are fabricated or haven’t been performed at all.
- In a presentation at an AANEM annual meeting, our Chief Clinical Officer Dr. Robinton, together with a former Medical Director of a top 10 insurance company, stated that more than 60% of reports submitted by uncredentialed providers were deemed to be of unacceptable quality.
- Poor quality and fraudulent providers cause unnecessary treatments for patients, such as pain injections and surgery.
More than 60% of reports submitted by uncredentialed providers were deemed to be of unacceptable quality.
What’s The Solution?
Educate
Learn how EMGs may be affecting your organization
Detect
Utilize A4D’s services to determine the medical usefulness of an EMG
Manage
Look for patterns of fraud and prepare to take legal action
Which Review is Best for You?
Individual Case
Review
If the original study is medically sound:
$200
Receive an email stating the absence of issues or concerns with the original study
-or-
If the original study shows cause for concern:
$500
Receive a summary report identifying the inadequacies of the original study
- Ad hoc
- Review of individual patient’s EMG
- Confirms or disputes medical usefuleness
Preliminary Provider Pattern Review
10 cases $5,000
Receive a multipage report and live discussion detailing our expert’s concerns
- Confirms or disputes medical usefulness
- Reviews work by a certain provider to determine patterns of fraud and abuse
- Assesses the need for a Comprehensive Provider Pattern Review
Comprehensive Provider Pattern Review
50 cases
$25,000
Receive an extensive report and live discussion detailing our expert’s concerns
- Clinically guided audit
- Review and analysis of EMG billing data
- Review for large patterns of fraud and abuse
- Customized plan for combatting fraud and/or recouping costs
Request More EMG Information
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