Medicare Compliance & Reimbursement

The OIG thinks nursing homes are bungling hospital stay data

Skilled nursing facilities whose staffers don't enter accurate hospital stay data on their Medicare claims will likely end up facing overpayment demands down the road. The HHS Office of Inspector General has its eye on the issue, and is hunting for errors at a number of Medicare contractors. In its latest review, "Ineligible Medicare Payments to Skilled Nursing Facilities Under the Administrative Responsibility of Veritus Medicare Services" (A-05-03-00035), the watchdog agency estimates that Medicare paid more than $6.3 million worth of overpayments that ought to be recovered. The errors occurred because the Centers for Medicare & Medicaid Services systems' don't have an automated cross-check to verify that a three-day inpatient hospital stay occurred prior to SNF admission - a requirement for eligibility. In the OIG's view, it's clear that SNFs are entering inaccurate hospital stay information, and the watchdog agency urges Veritus to pursue the overpayments. To see the report, go to http://oig.hhs.gov/oas/reports/region5/50300035.htm. Lesson Learned: Avoid overpayment demands by making sure your staff fills in correct hospital stay data on your Medicare claims.