HOSPITALS: Prepare For More Scrutiny Of Your Outpatient Billing

Why This Topic Matters

It helps hospitals and revenue cycle teams identify where federal auditors and program integrity efforts may focus, so they can review internal billing, documentation, and charge capture processes before claims are examined more closely.

Article Sections

1. Dialysis admissions and observation status

   Discusses review activity related to dialysis stays and the distinction between inpatient and observation-level care in hospital billing oversight.

2. Inpatient PPS wage indices

   Covers planned review of wage data used in inpatient prospective payment calculations and the potential impact of hospital-reported data on payment accuracy.

3. Inpatient hospital payments for new technologies

   Describes examination of payment and cost issues for newly introduced hospital services and technologies under Medicare payment systems.

4. Outpatient department payments

   Summarizes planned scrutiny of hospital outpatient department payment practices under the outpatient prospective payment system.

5. Outpatient outlier and charge-related issues

   Addresses review of outlier and other charge-related payment issues affecting hospital outpatient departments and community mental-health centers.

6. Unbundling of hospital outpatient services

   Covers concern about services that may have been billed separately when they are expected to be part of outpatient hospital services.

7. Inpatient-only services performed in an outpatient setting

   Discusses oversight of denied or disputed services that fall into an inpatient-only category when performed in outpatient settings, along with claims-processing edits.

8. Diagnostic x-rays in emergency departments

   Describes planned review of payment practices involving diagnostic imaging interpreted in hospital emergency departments.

9. Oversight of specialty hospitals

   Summarizes CMS and OIG attention to physician-owned specialty hospitals, including patient safety, quality, and staffing-related review areas.