St. Luke's Hospital in Chesterfield, Mo., failed to comply with Medicare billing requirements for 14 of 188 outpatient and inpatient claims reviewed by HHS' Office of Inspector General during the audit period of 2011 and 2012, according to a recent OIG audit report.
Here are five things to know about the audit.
1. The 14 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $119,721 in overpayments, according to the OIG.
2. Based on its findings, the OIG recommended the hospital refund the Medicare contractor $119,721 in estimated overpayments and strengthen its controls to ensure full compliance with Medicare requirements.
3. St. Luke's Hospital agreed with the OIG's findings for 12 of the 14 claims that were identified as having been billed in error, and described corrective actions that it had taken or planned to take to further enhance and strengthen its controls.
4. However, the hospital disagreed with the OIG's findings on two inpatient claims in which the OIG found that the hospital should have billed the claims as outpatient or outpatient with observation services. The hospital stated that both inpatient admissions were medically necessary in accordance with Medicare guidelines and added that it has processes in place for the review of all inpatient claims before discharge to ensure that inpatient status is billed appropriately. The hospital also said that it would appeal these two claims through the Medicare appeals process, according to the OIG.
5. After receiving the hospital's comments, the OIG maintained its findings and recommendations.
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