Medicare Compliance & Reimbursement
Care-Transfer Payouts May Need Re-Transferring
Warning: Inaccurate discharge status codes could cost acute care hospitals a bundle.
The Department of Health and Human Services Office of Inspector General conducted a nationwide review of acute care hospitals' compliance with Medicare's postacute care transfer policy during fiscal years 2001 and 2002, according to a recent report.
The OIG sampled 400 claims in its audit, 381 of which were improperly coded as patient discharges to homes instead of transfers to postacute care facilities. Medicare pays the full diagnosis-related group payment for a discharge, but only pays a per diem rate for transfers, which cannot exceed the discharge payment rate.
Some hospitals didn't have necessary controls to ensure the discharge status codes' accuracy, and the Centers for Medicare and Medicaid Services didn't have adequate payment system edits to prevent overpayments, the OIG says. Medicare overpaid hospitals $72.4 million for improperly coded discharges during the two years, the OIG estimates.
Result: CMS should instruct fiscal intermediaries to recover more than $1 million in potential overpayments identified in the sample, the OIG recommends. FIs should review remaining claims in the sample and recover the additional $71.3 million in overpayments.
The OIG also wants CMS to monitor hospitals with a high volume of adjusted claims resulting from recent system edits and perform follow-up reviews. CMS agreed to carry out the OIG's recommendations.
To read the audit, go to http://www.oig.hhs.gov/oas/reports/region4/40403000.htm.
Medicare Compliance & Reimbursement
- MEDICAID:
Advisory Commission Causing Controversy
Skeptics scoffing at claims of bipartisanship.
The new Medicaid advisory commission has a mammoth task: Figuring [...] - PHYSICIANS:
Consider The Source On Document Changes
Employees should be handled differently than outside entities.
If an entity outside of a physician's practice [...] - PHYSICIANS:
Bariatric Surgery Benefits From New BMI Codes
... but most doctors don't list body mass index on patient's charts.
Physicians' offices having trouble [...] - PHYSICIANS:
Medicare Issues New Smoking Cessation Codes
... but acupuncture cannot stick a permanent code.
Physicians who are gearing up to provide smoking-cessation [...] - HOSPITALS:
'Ghosting' Trend May Be Grafting Medicare
Outsourcing to other countries raises HIPAA questions, economic concerns.
Now the growing outsourcing problem extends beyond [...] - MEDICARE ADVANTAGE:
MA Plans Wise To Target MediGap Purchasers
MediGap's rural route can lead to a gold mine of customers.
Medicare Advantage plans looking to [...] - ASC:
CMS Officially OKs Ciliary Destructions In ASCs
Procedure has long been covered, CMS reports.
There's good news for ambulatory surgery centers that perform [...] - HOME HEALTH:
Hospital Transfer Policy Could Choke Off Referrals
CMS proposes reducing DRG payments for patients who go to home care.
Home health agencies trying [...] - ACUTE CARE HOSPITALS:
Care-Transfer Payouts May Need Re-Transferring
Why the OIG wants CMS to collect millions in potential overpayments.
Warning: Inaccurate discharge status codes [...] - ENFORCEMENT WATCH:
The Big Payback: OIG Says OK Owes For Overages
An audit of Medicaid billings proves costly for state.
When the feds order hefty paybacks from [...] - LONG-TERM CARE:
MedPAC Wants To Subtract Add-On Payments
Proposal would also nix inflation adjustment.
Medicare revenues for long-term care providers won't crash come October. [...] - BILL WATCH
The following bills were introduced in the Senate: S. 1081. A bill to amend title [...]
