Home Health & Hospice Week

Findings from a recent OIG audit may make your hospital referrals more elusive than ever.

“Medicare improperly paid acute-care hospitals $54.4 million for 18,647 claims subject to the transfer policy” from 2016 to 2018, the HHS Office of Inspector General says in its report. The hospitals “coded these claims as discharges to home (16,599 claims) or to certain types of healthcare institutions (2,048 claims), such as facilities that provide custodial care, rather than as transfers to post-acute care.”

Bad news: “Of these claims, 83 percent were followed by claims for home health services, and 17 percent were followed by claims for services in other post-acute-care settings,” the OIG says.

The Centers for Medicare & Medicaid Services agreed with the OIG’s recommendations to recover the $54.4 million from hospitals; identify more claims that should have been prorated; and make sure Medicare contractors are adjusting claims for PAC proration going forward.

CMS began prorating hospital DRG payments for “early” discharges back in 1999 (see Eli’s HCW, Vol. XIII, No. 22).

The 21-page OIG report is at https://oig.hhs.gov/oas/reports/region9/91903007.pdf.