Medicare overpaid hospitals $267M, OIG says

The inspector general made numerous suggestions, consisting of that CMS recuperate a part of the overpayments, recycle the remaining inpatient claims in the OIGs sample frame with an inaccurate client discharge status or condition code, correct its associated system edits and consider decreasing the requirement for medical judgment when processing claims under the post-acute care transfer policy..

” Medicare needs to have paid these inpatient claims utilizing a finished daily rate rather than complete payment,” the OIG stated..

For financial years 2016 and 2017, the OIG took a look at a sample of 150 claims at threat of overpayment and had an independent medical review professional evaluate the medical records..

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Of the 150 claims in the sample, Medicare correctly paid three and improperly paid 147 with $722,288 in overpayments..

The inspector general did the review after previous audits recognized overpayments due to the fact that medical facilities did not abide by Medicares post-acute care transfer policy. Subsequent analysis suggested hospitals may be using condition codes to bypass CMS system edits to receive higher compensations for inpatients moved to house health services, the OIG stated..

Based on its sample results, the OIG estimated that Medicare incorrectly paid $267 million to medical facilities over the two-year duration..

” Medicare improperly paid most inpatient claims subject to the transfer policy when recipients resumed home health services within 3 days of discharge however the medical facilities stopped working to code the inpatient claim as a discharge to home with home health services or when the health centers applied condition codes 42 (home health unrelated to inpatient stay) or 43 (home health not within 3 days of discharge),” the OIG stated..

CMS accepted most of the OIGs suggestions, according to the report..

Medicare paid too much hospitals more than $267 million over a two-year period for inpatient claims with post-acute care transfers to house health services, according to a report from HHS Workplace of Inspector General..

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