Health Information Management

Healthcare News: OIG determines inpatient rehabilitation facilities receive millions of dollars in MAC overpayments

JustCoding News: Inpatient, October 10, 2012

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The OIG estimates that Medicare Administrative Contractors (MAC) paid $8.4 million in overpayments to inpatient rehabilitation facilities (IRFs) because IRF and Medicare payment controls did not adequately identify late submissions of patient assessment instruments (PAI).

IRFs must electronically transmit a PAI for each IRF stay to the National Assessment Collection Database within 27 calendar days from (and including) the beneficiary’s discharge date. If an IRF submits the PAI after this timeframe, its payment rate for the applicable case-mix group should incur a 25% late-assessment penalty.
The OIG sampled 108 claims with dates of service in calendar years 2009 and 2010. MACs either cancelled or correctlu paid 20 of these claims. For the remaining 88 claims, MACs did not reduce the payments to IRFs even though IRFs transmitted the PAIs after the 27-day deadline.
The OIG announced its findings as well as several recommendations in a report published in September.

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