OIG: Hospital failed to follow year-end claims billing rules
Compliance Monitor, September 21, 2005
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The OIG found that a Maine hospital did not bill fiscal year-end claims for its inpatient rehabilitation facilities (IRF) in accordance with Medicare regulations. As a result, Medicare made net overpayments totaling $254,915. The hospital received inaccurate information from its fiscal intermediary that contributed to the problem of split billing in 2003 and 2004.
The OIG recommended that the hospital
continue to work with its fiscal intermediary to complete a voluntary repayment process
determine the resulting effect on its Medicare cost reports for 2002 - 2004
The OIG took the following steps to complete the audit:
Reviewed applicable Medicare laws, regulations, and guidance
Extracted paid claims data for 2002, 2003, and 2004 from CMS's National Claims History and the fiscal intermediary's claims processing system
Identified a universe of 76 inpatient rehabilitation claims incorrectly billed by the hospital at its fiscal year end
Reviewed applicable detailed records for the claims from CMS's Common Working File to verify that the claims represented a single inpatient rehabilitation stay
Calculated the effect of incorrect billing by using CMS's Pricer Program
Discussed the results of the review with the hospital's fiscal intermediary, Associated Hospital Service, Inc.
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