No issues found during audit of EEG claims

OIG auditors reviewed 30 claims for ambulatory electroencephalograms (EEG) submitted by Cook Children's Medical Center and found that the provider complied with the tested regulations in all encounters. The reviewed ambulatory EEG procedure monitors the electrical activity in a patient's brain through small metal electrodes attached to the patient's scalp. Unlike routine EEGs, which are conducted in a medical facility and last less than an hour, an ambulatory EEG can last up to 72 hours and allows the patient to return home during the monitoring period.

The audit selected encounters from November 2020 through August 2021 to determine if the provider met select requirements during a fiscal year when the provider received nearly $3.3 million from Medicaid to conduct the procedure on clients.

To test the encounters, medical records were compared to submitted claims. This allowed auditors to determine whether the ambulatory EEG set-up was performed with the corresponding claim or if the record showed a set-up for a routine EEG that occurred the previous day. In addition to the medical record and billing reviews, the audit involved interviews with Cook Children's management and staff responsible for policies and procedures relating to Medicaid claims.