OIG reviews claim payment adjustments for QIOs
Healthcare Auditing Weekly, December 26, 2007
The OIG found fiscal intermediaries properly processed the majority of payment adjustments for claims referred by the quality improvement organizations (QIO) for fiscal year 2005, according to an OIG audit.
The OIG determined fiscal intermediaries properly adjusted 3,440 (96.4%) of the 3,568 claims referred based on the QIOs' case reviews and final determinations during FY 2005 Hospital Payment Monitoring Program. Fiscal intermediaries did not properly adjust 128 claims with net overpayments totaling $415,677.
The OIG recommended CMS:
- Instruct fiscal intermediaries to recover $415,677 for 128 claims identified with errors
- Follow up with the QIOs and fiscal intermediaries when adjustments are not processed promptly
CMS agreed with the first recommendation, but disagreed with the second.
Click here to read the OIG audit report.
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