The billing errors — which included nine inpatient rehabilitation claims that did not meet coverage requirements as well as nine outpatient claims that were incorrectly coded — resulted in overpayments of $201,624, according to the report, which covered the two-year audit period of January 1, 2016, through December 31, 2017. Extrapolating from the sample results, the OIG estimated Northwest Medical Center received at least $1.2 million in overpayments from Medicare during the audit period.
“During the audit, the hospital submitted six of these claims for reprocessing, and we verified those claims as correctly reprocessed,” the OIG added. “Accordingly, we have reduced the recommended refund by $4,024.”
Based on its findings, the OIG recommended the hospital refund the Medicare contractor at least $1.2 million, work reasonably to identify and return any additional similar overpayments outside of the audit period and strengthen controls to ensure full Medicare compliance.
The OIG said Northwest Medical Center disagreed that it incorrectly billed inpatient rehabilitation claims, beneficiary stays that were supposed to be billed as outpatient and outpatient claims with bypass modifiers. The medical center also disagreed with the OIG’s use of extrapolation, among other things, the office said.
The OIG maintained its findings and recommendations.
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