Part B Insider (Multispecialty) Coding Alert

Published on Mon Sep 15, 2014 PDF

Nobody likes to get audited by the OIG, but the American Hospital Association (AHA) has taken its disdain for these audits up a notch by formally asking HHS Secretary Sylvia Burwell to rethink the way it calculates Medicare errors when completing audits.

The AHA believes that extrapolation—using a small sampling of claims to calculate an error rate, and then using that error rate to estimate the complete misbilled amount among the entire entity’s charts—is a flawed system, and would like it to be eliminated, wrote the AHA’s Executive Vice President Rick Pollack in an Aug. 21 letter to Burwell.

“The OIG’s approach grossly exaggerates estimated Medicare overpayments, leads to excessive recoveries by Medicare contractors, and otherwise prejudices and burdens hospitals,” Pollack says in the letter. 

To read more about this issue, visit the AHA’s website at www.ahanews.com.