Medicare Compliance & Reimbursement

Losing track of inpatients could cost hospitals bundles of reimbursement.

Do hospitals know where their patients are? They'd better, or they risk losing out on Medicaid dollars to which they're entitled.
 
Hospitals need to pay close attention to coding problems that could be sending the wrong message to Medicaid about their inpatient transfers and discharges. As the HHS Office of Inspector General continues pursuing discharge/transfer miscoding in hospitals nationwide, the Tarheel State is the latest to get burned with a financial adjustment.
 
The North Carolina audit, titled "Audit of Hospital Patient Transfers Paid as Discharges and Claimed Under the North Carolina Medicaid Program" (A-05-03-00041), revealed that 111 hospitals routinely coded same-day inpatient hospital transfers as either discharges to the home or to self-care, or as a discharge/transfer to another facility type. More than 500 claims in 35 of those facilities resulted in overpayments worth $1.8 million.
 
The OIG recommended that the state step up proper data entry practices at hospitals, emphasizing the importance of coding every transfer with the appropriate "02" in the patient status box. System errors also played a role: Monthly medical record utilization reviews were not effective at detecting all overpayments. Instead, postpayment edits were needed to catch all improperly coded transfers, according to the report.