In Savannah Georgia, a 612-bed hospital, Memorial University Medical Center, was cited for failure to comply with Medicare billing requirements. With a review which consisted of 131 mixed inpatient and outpatient claims 39 of them failed an inspection for compliance.
The HHS office of inspector general places strict compliance provisions over billing for Medicare services. The compliance requires several different ongoing markers to be measured to ensure accurate billing which conforms with the standards. If any of the standards are found to be missing it is possible for a citation to take place.
Based on the OIG results it is estimated that MUMC received more than 1.4 million in overpayments from Medicare. A recommendation has been made that Medicare should be refunded as much as $1.3 million after adjusting for reprocessing. A claw back of such revenue is an example of how healthcare organizations put themselves at risk when not properly exercising required compliance monitoring and other compliance related checks.
When given the opportunity to comment MUMC did disagree with 17 of the 39 claim errors identified during the OIG audit as some of the claims were not in fact audited by the OIG but by a third party who denied MUMC to provide additional information related to the claim. Regardless of this statement the OIG has maintained its findings and recommendations.
Overbilling and improper claims management common areas for OIG inspections and during those inspections there are exposures that can be prevented by simply complying with compliance standards set by CMS. MedTrainer can help identify compliance gaps and provide solutions to help promote compliance with CMS that help reduce or prevent OIG audit findings which lead to penalties and claw backs. Contact MedTrainer today to learn more. www.medtrainer.com