Corporate Compliance

Other Issuances: OIG reviews excessive outpatient claims, and more

Medicare Insider, May 18, 2010

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OIG audits excessive outpatient claims

On May 3, the OIG issued an audit report in which it found that for calendar years 2004 through 2007, all of Swedish Medical Center – Cherry Hill billed incorrect claims resulting in overpayments totaling approximately $103,000. The OIG determined that:

  • For four claims, Cherry Hill billed for a replacement device without the required FB modifier and applicable condition codes
  • For two claims, Cherry Hill billed for an injection of reteplase rather than an application of a small dose for cleaning catheters
  • For one claim, Cherry Hill billed for a replacement device rather than a pacing lead
  • For one claim, Cherry Hill billed for a service provided to a research study patient that should not have been billed to Medicare

View the OIG report.

OIG issues report on interrupted stays at IPFs

On May 4, the OIG issued a nationwide review of Medicare payments for interrupted stays at inpatient psychiatric facilities (IPF). Based on a sample of 100 claims, the OIG estimated that Medicare fiscal intermediaries made $3.9 million in improper payments to IPFs nationwide in calendar years 2006 and 2007 for claims on behalf of beneficiaries who had been discharged from another IPF within the prior 3 days. To discourage inappropriate discharges and readmissions to IPFs, CMS has established a 3-day policy for interrupted stays. An interrupted stay occurs when a beneficiary is discharged from an IPF and admitted to the same or a different IPF within 3 consecutive days. In such a case, the “readmission” is considered a continuation of the initial stay.

View the OIG report.



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