Medicare Compliance & Reimbursement

Communication breakdowns lead to big billing problems for both. Suppliers' claims are coming up short on compliance for Part B services under a Part A skilled nursing facility stay.

But according to the HHS Office of Inspector General, SNFs share the blame. A nationwide OIG audit of claims from 1999 and 2000 revealed that Medicare often paid twice for the same service -- once to a SNF under the Medicare Part A prospective payment system and again to an outside supplier under Medicare Part B. The result was $108.3 million in overpayments that the OIG says it will be coming to collect.

The Centers for Medicare & Medicaid Services' 2002 edits help ensure consolidated billing compliance by directing suppliers when to bill and receive payment from a SNF instead of Medicare. But problems persist, the OIG says. According to report, titled "Review of Improper Payments Made by Medicare Part B for Services Covered Under the Part A Skilled Nursing Facility Prospective Payment System in Calendar Years 1999 and 2000" (A-01-02-00513), suppliers can still bill and be paid by Medicare before the SNF submits their PPS claims. To prevent overpayments, the OIG wants CMS to work with its contractors to hammer out better billing controls between SNFs and suppliers. The billing controls include the following: SNFs need to get quick and accurate info to suppliers regarding who they should bill for services provided to residents in Part A stays; contractual agreements between SNFs and suppliers could help specify compliance responsibilities; and data analysis techniques could be used to identify and penalize SNFs and suppliers whose claims are repeatedly adjusted by CMS edits. To read the report, go to http://www.oig.hhs.gov/oas/reports/region1/10200513.htm.