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Health Law News |
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May
4, 2009 |
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Hall, Render, Killian, Heath & Lyman is a
full service health law firm with offices in Office Locations
Contact: Neal A. Cooper
Wisconsin Office Contact Us |
OIG finds
Inpatient Rehabilitation Facilities Incorrectly
Billed Medicare for Interrupted Stays On
May 1, 2009, the Office of the Inspector General released Audit Report no.
A-01-08-00502, entitled Review of Interrupted Stays at Inpatient
Rehabilitation Facilities for Calendar Years 2004 and 2005 (available at
http://www.oig.hhs.gov/oas/reports/region1/10800502.asp). According to the OIG report, the error
is isolated to inpatient rehabilitation facilities that furnished services to
Medicare patients with discharge dates during calendar years 2004 and
2005. The specific error related
to interrupted stays. Medicare
payment rules indicate that, where a Medicare inpatient returns to the same
IRF from which the patient was discharged, within 3 consecutive calendar days
of the discharge, the "interrupted stay" constitutes a single claim
for which the IRF should receive a single discharge payment. The
OIG identified 448 IRFs that purportedly billed incorrectly for 986 interrupted
stays during calendar years 2004 and 2005. For those stays, the IRFs were paid
$21.7 million, but should only have received $17.5 million. The difference of $4.2 million,
according to the OIG, is the net aggregate overpayment to IRFs for interrupted
stays. The OIG blames the payment
errors on IRFs failing to have "necessary controls to identify or
correctly bill interrupted stays," although the OIG also acknowledges
that, until April 2005, CMS did not have an edit designed to identify all
interrupted stays billed as two or more claims. CMS has implemented an edit in the
Common Working File to detect incorrectly billed interrupted stays and
prevent overpayments to IRFs.
This edit resulted from a previous audit of calendar year 2002 and
2003 IRF interrupted stays, in which the OIG identified a $5.9 million net
aggregate overpayment to IRFs. IRFs
should anticipate that CMS contractors will seek to recoup $4.2 million in
overpayments for these interrupted stays. In its comments to the OIG's report,
CMS requested provider-specific overpayment data so that it may instruct its
contractors to recover these amounts.
IRFs may simply await the overpayment demands, which will average less
than $10,000 per facility. IRF
sizes vary widely, however, so this average overpayment may not be indicative
of an individual IRF's overpayment assessment. It may thus be advisable for IRFs to
independently determine whether an overpayment exists for interrupted stays,
both for budgetary purposes and to evaluate the accuracy of any overpayment
assessment the contractor may issue. If you have questions regarding this issue, please contact your regular Hall Render attorney, or Neal A. Cooper at ncooper@hallrender.com (317-977-1455). This publication is
intended for general information purposes only and does not and is not
intended to constitute legal advice. The reader must consult with legal
counsel to determine how laws or decisions discussed herein apply to the reader's
specific circumstances. |
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