Medicare Compliance & Reimbursement

Hospitals face ever-mounting attention on Medicare outlier payments - and are bracing for a new rule on the subject that industry associations fear will devastate some facilities. But while some hospitals are surely gaming the system to boost their reimbursement, in most cases outlier errors end up producing both overpayments and underpayments. The recent HHS Office of Inspector General report "Review of Outlier Payments Made to the Baystate Medical Center Under the Outpatient Prospective Payments System For The Period August 1, 2000 Through June 30, 2001" (A-01-02-00528) makes the point. While the OIG found errors in 37 of the 38 claims it reviewed, the mistakes sometimes included underpayments to the hospital - and the net overpayment for the $145,000 worth of claims only turned out to be $7,900. Most of the errors involved medications billed under revenue center code (RCC) 250- Pharmacy instead of the pertinent ambulatory payment classification code. To see the report, go to http://oig.hhs.gov/oas/reports/region1/10200528.pdf.