tci Medicare Compliance & Reimbursement - 2003 Issue 15

Hospitals: OUTLIER BLUNDERS GO BOTH WAYS

Hospitals face ever-mounting attention on Medicare outlier payments - and are bracing for a new rule on the subject that industry associations fear will devastate some facilities. But while some hospitals are surely gaming the system to boost their reimbursement, in most cases outlier errors end up producing both overpayments and underpayments. The recent HHS Office of Inspector General report "Review of Outlier Payments Made to the Baystate Medical Center Under the Outpatient Prospective Payments System For The Period August 1, 2000 Through June 30, 2001" (A-01-02-00528) makes the point. While the OIG found errors in 37 of the...

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