News: OIG begins follow-up audit of outpatient services provided to inpatients

CDI Strategies - Volume 52, Issue 2

The Office of Inspector General (OIG) will be conducting a second round of audits to determine whether acute care hospitals are being inappropriately reimbursed for outpatient services provided to inpatients, according to an update to its Work Plan, Revenue Cycle Advisor reported.

The new round comes after a previous audit discovered Medicare overpaid acute care hospitals $51.6 million for outpatient services provided to inpatients of other facilities, including critical access hospitals (CAH) and inpatient rehabilitation facilities (IRF), from 2013 to 2016. Under Medicare’s rules, only the facility at which the patient is an inpatient is reimbursed for covered hospital services. The inpatient facility, including CAHs and IRFs, must furnish all necessary services directly or under arrangement.

The OIG’s previous audit found that in all of the cases reviewed, the inpatient facilities were responsible for payment, and that overpayments occurred because CMS’ common working file edits were not working. The previous audit also found that acute care hospitals collected $14.3 million in unnecessary deductibles and coinsurance for these services.

The follow-up audit will determine whether CMS corrected the edits and ensure that they are working properly.

Editor’s note: This article was originally published in Revenue Cycle Advisor.

Found in Categories: 
Denials & Appeals, News, Outpatient CDI

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