Two separate hospital audits from the HHS Office of Inspector General have found more than $2 million in cumulative Medicare overpayments.
At UMass Memorial Medical Center, a 781-bed academic medical center in Worcester, Mass., the OIG looked at inpatient and outpatient claims from 2010 and 2011. Of the audited sample claims, more than two-thirds involved errors — most of which stemmed from incorrectly billing services as inpatient when they should've been outpatient. The OIG said this led to almost $1.65 million in Medicare overpayments, which UMMC is expected to refund.
UMMC officials agreed with most of the OIG's findings and said they would strengthen Medicare billing guidelines, but the hospital planned to appeal a few claims involving discharge codes.
At Baylor All Saints Medical Center at Fort Worth (Texas), a 525-bed hospital within Dallas-based Baylor Scott & White Health, the OIG found $371,952 in Medicare overpayments. Similar to UMMC, a vast majority of the billing errors came on the inpatient side and involved inpatient/outpatient determinations and separate inpatient stay codes.
Baylor officials agreed with some of the OIG's findings but argued that all of its inpatient claims were legitimate and relied on sound physician documentation. "[The hospital] provided inpatient level of care services based on the physician order and the patients' presenting condition," according to the report. Baylor plans to challenge those claims through the Medicare appeals process, but the OIG said it stood by its audit.
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