Strengthening Medicare Part A billing requirements for inpatient stays related to canceled elective surgeries could save millions of dollars, according to a report from HHS' Office of the Inspector General.
In calendar years 2009 and 2010, Medicare paid an estimated $38.2 million in claims for hospital stays involving canceled elective surgeries. Using a sample of 100 of these claims, the report determines that 80 did not fit Medicare's billing requirement that the admissions be "reasonable and necessary." The sampled 80 claims resulted in $345,717 in overpayments (not adjusted for Part B rebilling).
The report recommends CMS strengthen oversight of claims to ensure that a clinical condition requiring inpatient care exists for Medicare Part A billing, and work with the OIG to investigate and recover funds from claims involving canceled elective surgeries.
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