Errors Billing Outpatient Services When Patient is also Inpatient

by  Wyn Staheli, Director of Content - innoviHealth
Nov 29th, 2018

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