Medicare Compliance & Reimbursement

Hospitals that received CARES Act Provider Relief Fund (PRF) payments were required to follow certain billing rules for COVID-19 patients as part of their funding agreements — but some didn’t and now the feds are looking into that.

Lowdown: The HHS Office of Inspector General’s (OIG) new Work Plan item, W-00-22-35878, focuses on the intersection of hospitals’ compliance with the PRF payment rules, patients’ rights, and balance billing. “Under the PRF terms and conditions, hospitals are eligible for PRF distribution payments if they attest to specific requirements, including a requirement that providers, such as hospitals, must not pursue the collection of out-of-pocket payments from presumptive or actual COVID-19 patients in excess of what the patients otherwise would have been required to pay if the care had been provided by in-network providers,” the OIG says.

This “surprise billing” issue, which OIG refers to as a “balance billing requirement” is what the agency plans to review. Hospitals’ PRF payments and attestations related to the “associated terms and conditions complied with the balance billing requirement for COVID-19 inpatients,” will be audited, the Work Plan item suggests.

Read the active item at https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000647.asp.