HCPro, JustCoding Outpatient - 2020 Issue 38 (October)
Healthcare News: OIG audit targets outpatient billing for outlier payments
October 6th, 2020
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Article Overview
This article covers an Office of Inspector General review of outpatient hospital billing under Medicare’s OPPS, focusing on outlier payments, claim accuracy, and the types of billing errors identified in a hospital audit. It is relevant to hospital billing staff, outpatient coders, compliance teams, auditors, and revenue cycle professionals who monitor Medicare payment integrity and outpatient claim accuracy. The piece also summarizes the OIG’s findings, the hospital’s response, and the broader compliance significance of proper billing for high-cost outpatient services.
Why This Topic Matters
It highlights how outpatient billing errors can affect Medicare outlier payments and trigger audit findings, overpayments, and corrective action. Readers can use it to understand the compliance focus areas involved in outpatient hospital claims and billing oversight.
Article Sections
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OIG review of outpatient outlier payments
Summarizes the Medicare audit context, the hospital reviewed, and the scope of the OIG’s examination of outpatient outlier payment claims.
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Sample review and audit findings
Describes the claim sample, the audit period, and the general pattern of billing and coding issues identified in the reviewed outpatient claims.
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OIG recommendations and hospital response
Outlines the audit recommendation, the repayment amount cited, and the hospital’s stated corrective response.
What You Will Learn
- The Medicare outpatient payment context addressed by the audit
- How the article frames claim review and billing accuracy issues
- The general categories of billing and coding errors discussed
- The audit outcome and the hospital’s response
Who Should Read This
- Hospital outpatient billing teams
- Medical coders
- Compliance officers
- Revenue cycle professionals
- Healthcare auditors
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