Errors Billing Outpatient Services When Patient is also Inpatient

The OIG recently reported that Medicare inappropriately paid acute-care hospitals for outpatient services provided to patients who were inpatients of another facility including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals.  CMS suggests using the following resources to ensure compliance:

• Medicare Inappropriately Paid Acute-Care Hospitals for Outpatient Services They Provided To Beneficiaries Who Were Inpatients of Other Facilities. OIG Report, September 2017
• MLN Matters® Special Edition Article
• Provider Compliance Tips for Ordering Hospital Outpatient Services Fact Sheet
• Acute Care Hospital Inpatient Prospective Payment System Fact Sheet: See payment information on page 3
• Items and Services Not Covered Under Medicare Booklet, Page 12
• Medicare Claims Processing Manual, Chapter 3, Section 10.4 

Wyn Staheli is the Director of Content Research & Editing for Find-A-Code. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.

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