Moses H. Cone Memorial Hospital in Greensboro, N.C., failed to comply with Medicare billing requirements for 73 inpatient and outpatient claims reviewed by HHS' Office of Inspector General during the audit period of 2012, according to a recent OIG audit report.
Here are eight things to know about the audit.
1. The 73 claims that did not fully comply with Medicare billing requirements resulted in the hospital receiving $457,590 in overpayments, according to the OIG. Specifically, 70 inpatient claims had billing errors, resulting in net overpayments of $430,418, and three outpatient claims had billing errors, resulting in overpayments of $27,172.
2. Based on the sample results, the OIG estimated the hospital received at least $1.83 million in overpayments from Medicare during the audit period.
3. The OIG recommended the hospital refund the Medicare contractor $1.83 million in estimated overpayments and strengthen its controls to ensure full compliance with Medicare requirements.
4. In response to the OIG's findings, Moses H. Cone Memorial Hospital pointed out that the OIG drew the sample from a sample frame that included claims from four hospitals that all bill under the same provider number. Therefore, the hospital contended that the sample was flawed and extrapolation was invalid.
5. The hospital said it disagreed with many of the OIG's incorrect coding determinations and that it intends to appeal adverse determinations that are appropriately supported in the medical records, according to the OIG.
6. The hospital also disagreed with the OIG's determination that one claim was billed with the incorrect discharge status code because it did not know the patient received home health services after discharge.
7. Finally, the hospital acknowledged errors in billing outpatient claims for medical devices and described steps it had taken to ensure that such errors do not happen in the future.
8. After receiving the hospital's comments, the OIG disagreed with the hospital's contention that the sample was flawed and that extrapolation was not valid, and maintained that the hospital billed the disputed claims incorrectly.
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