OIG Examines CMS Payments to Hospitals for Clinic Visits

OIG Examines CMS Payments to Hospitals for Clinic Visits

The HHS Office of Inspector General (OIG) estimates that CMS made $4.six million in incorrect Medicare outpatient payments to hospitals for established patients’ clinic visits this year. Based on the OIG, hospitals attributed the wrong payments to staff making clerical and programing errors, not verifying if the patient was registered being an inpatient or outpatient from the hospital in the past three years (and therefore considered a recognised instead of new patient), not following hospital procedures, not fully understanding Medicare billing needs for clinic visits, and counting on the code the treating physician billed for your visit. The OIG also observes that CMS doesn’t have edits in position to recognize Medicare payments for patients who have been already registered in a facility. The OIG recommends that CMS use its Medicare administrative contractors to recuperate identified incorrect payments and resolve additional potential overpayments towards the extent achievable. To learn more, begin to see the full report, “CMS Didn’t Always Properly Make Clinic Visit Payments to Hospitals During Twelve Months 2012.”

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